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^® (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 (rs = -0.560, p = 0.024; rs = -0.563, p = 0.023, respectively), and a thinner LLT was observed (rs = 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.