Long-Term Clinical Findings of Retained Intraocular Ink After Scleral Tattooing: Insights Into the Ocular Glymphatic System

Abstract

Purpose: To report the long-term clinical course, imaging findings, and histopathologic analysis of inadvertent globe penetration during scleral tattooing, with emphasis on intraocular particulate migration. Methods: A single case was reviewed. Results: A 41-year-old woman presented with inadvertent globe penetration following scleral tattooing. She underwent immediate pars plana vitrectomy, anterior chamber washout, and cataract extraction (June 2017), followed by a second vitrectomy with capsulotomy and sulcus intraocular lens implantation (February 2018). Her clinical course was complicated by persistent intraocular hyperreflective material, white retinal deposits, macular edema, and development of an epiretinal membrane with lamellar macular hole formation. A third vitrectomy with preretinal membrane removal was performed in June 2024. Analysis of vitrectomy fluid and preretinal tissue revealed monocytic cells, pigment-laden giant cells, and elevated intraocular barium concentrations. Serial multimodal imaging demonstrated centripetal and intraretinal migration of characteristic paravascular deposits, suggesting progressive distribution of retained particulate material. Conclusions: This 7-year follow-up of inadvertent intraocular tattoo pigment deposition demonstrates sustained particulate migration within the retina. These findings provide clinical and histopathologic evidence supporting the existence of a retinal glymphatic-like clearance pathway for intraocular foreign material.