Corneal tattooing is a well-described procedure for reconstructive cosmetic purposes [1] and for optical purposes [2]. It can serve as an excellent alternative to the use of cosmetic contact lens. However, it is often difficult to explain to patients the cosmetic outcome of the procedure. We describe the use of digital image editing software to aid pre-op counselling.

Case

A 42-year-old man presented with a blind left eye and a scarred and opaque left cornea after childhood trauma. He was bothered by the appearance of the eye (Fig. 1a). He failed a trial of cosmetic contact lens—he found it inconvenient and hard to handle the lens and eventually lost it. He was offered corneal tattooing but was concerned with the post-operative cosmetic outcome of the procedure.

Fig. 1
figure 1

Preoperative photograph (a) showing the opaque left cornea. Photo editing of the photograph simulated the post-operative appearance (b). The actual appearance 6 weeks after surgery (c) was similar to the simulation

Full size image

To aid preoperative counselling, we used digital photograph-editing software (Powerpoint, Microsoft, Redmond, WA, USA) to alter a picture of his face and simulate the outcome of corneal tattooing (Fig. 1b). After counselling, he was keen to proceed.

The surgery was carried out using black sterile medical ink used in radiotherapy patients (off-label use). A 4-mm “pupil” was marked on the corneal surface with a skin trephine dipped in gentian violet. A 300-micron incision was made circumferentially around this mark for 90°. A lamellar dissection was performed within the limits of the “pupil” mark. The ink was injected and spread within this pocket and the incision was closed with a single interrupted 10-0 nylon suture. The tip of a curved needle from a 10.0 nylon suture was dipped in the ink and used to mark the peripheral cornea with a series of short tangential passes in order to simulate the slightly darker appearance near the limbus of light irides. The patient was prescribed dexamethasone 0.1% qds and G Chloramphenicol 0.5% qds post operatively.

post-operative appearance closely resembled the preoperative simulation and the patient was pleased (Fig. 1c).

Discussion

Failure to meet the cosmetic expectation and perceived deficits in informed consent can cause dissatisfaction for patients after facial cosmetic procedures [3]. We report a case of a satisfied patient where the outcome of surgery was very similar to that seen in the simulation created preoperatively on photo-editing software. Use of such software is an easily accessible and effective tool to counsel patients of the outcome of cosmetic corneal tattooing preoperatively.