Two cases of pen ink scleral tattoos and a brief review of the literature.

PURPOSE: Scleral tattooing, also known as episcleral, subconjunctival, or simply eyeball tattooing, is a relatively new form of extreme body modification that first emerged in 2007. There are few reports of the management of these tattoos in the medical literature, and we aim to increase the body of knowledge surrounding this rare and potentially dangerous practice. OBSERVATIONS: We present two new cases of improvised scleral tattooing, both performed in prison using pen ink and insulin needles, and both with minimal complications and managed with topical medications. A brief review of the literature is included which details the dangers of scleral tattooing. CONCLUSIONS AND IMPORTANCE: We discuss management of complications for this new, previously unreported method of scleral tattooing using pen ink. Ophthalmologists should be aware of the presentation, possible complications, and management of these cases.