The Effect of Eyeliner Tattoo on Meibomian Gland Dysfunction and the Ocular Surface

Purpose: To determine whether eyeliner tattoo affects the meibomian gland (MG) and ocular surface. Methods: The medical charts of an eyeliner tattoo group (16 eyes of 8 patients) and a control group (16 eyes of 18 patients) were retrospectively reviewed. The ocular surface disease index questionnaire, ocular surface staining score, tear film break-up time (TBUT), upper eyelid abnormality, meibum expressibility and quality, and MG loss and tear film lipid layer thickness (LLT) which measured with LipiView (R) (TearScience, Morrisville, NC, USA) were compared. In the tattoo group, the correlation between the distance from the MG orifice to the tattoo pigment and other indices were analyzed. Results: Compared to controls, the tattoo group had a significantly higher ocular surface disease index (p = 0.002), shorter TBUT (p < 0.001), higher vessel engorgement of the upper lid (p = 0.016), poorer meibum expressibility and quality (p = 0.006 and p < 0.001, respectively), higher MG loss (p < 0.001), and thinner LLT (p = 0.024). In the tattoo group, the closer the tattoo was to the MG orifice, the more the upper lid vessel was engorged and the more MG loss occurred (r(s) = -0.560, p = 0.024; r(s) = -0.563, p = 0.023, respectively), and a thinner LLT was observed (r(s) = 0.567, p = 0.022). Conclusions: Eyeliner tattoos may be related to changes in the lid margin, loss of the MG, and thinning of the LLT.