Tattoo-Associated Uveitis: An Emerging Eye Health Challenge.

BACKGROUND

Tattoo-associated uveitis is a potentially sight-threatening condition driven by a presumed immune reaction to tattoo ink. Case numbers may be rising as tattooing becomes more popular. Australian uveitis specialists collaborated to collect cases and better define this entity and its implications.

METHODS

Multicentre retrospective case review of collaborating uveitis specialists from January 2023 to January 2025. Following literature review, patients were recruited from public and private practices in Australian cities. Demographic information, clinical findings, investigations, treatment and disease course were collected.

RESULTS

The majority of affected individuals (21/40, 52.5%) were young adults of Caucasian or European ethnicity (28/40, 70%) with a predominance of bilateral (38/40, 95%) and anterior (28/40, 70%) uveitis. Inflammation within tattoos was present in all cases, most commonly associated with black ink. Systemic treatment was needed in 27/40 (67.5%) of whom 25/40 (62.5%) required steroid-sparing immunosuppression, most commonly methotrexate. Biological DMARDs were required in 17/40 (42.5%). Only 10 (25%) patients were adequately treated with topical treatment alone and just 11/40 (27.5%) had enduring remission off treatment during the reporting period. Complications included cataracts, cystoid macular oedema, and glaucoma. Only 3 patients had no visual loss during the course of their care.

CONCLUSIONS

Forty cases of tattoo-associated uveitis were identified, indicating that this previously rare condition has become a regular entity in Australian uveitis clinics in a population where 25% of people have tattoos. Vision was commonly affected, and 63% required long-term immunosuppression, including with biological DMARDs in 42%, making this a public eye health issue of concern.