Keratopigmentation: The Medical Technique for Changing Eye Color

What are the principles of keratopigmentation?

Keratopigmentation, or corneal tattooing, consists of inserting mineral or organic pigments into the superficial layers of the cornea. It originates from the ancient practice of corneal tattooing used to mask leukomas or restore an aesthetic appearance after corneal opacification.

The femtosecond laser now makes it possible to create an intra-corneal tunnel of constant depth and diameter, into which the ophthalmologist surgeon injects the pigments. This precision reduces the risk of irregular diffusion and improves color stability over time.

From medical purpose to aesthetic use for changing eye color

Historically, keratopigmentation aimed to correct or conceal corneal abnormalities:

• Post-traumatic or post-infectious scar leukomas
• Partial aniridias
• Corneal dyschromias
• Photophobia related to an atonic pupil

Aesthetic use has developed more recently, driven by demand from people wishing to modify the apparent color of their eyes, most often to make them lighter.

Unlike colored intraocular implants, which require an incision in the anterior chamber and expose patients to serious complications (glaucoma, endothelial decompensation, inflammation), keratopigmentation remains extraocular: in other words, it does not penetrate the globe and preserves internal structures.

How is the procedure performed?

The procedure is performed under topical anesthesia, using anesthetic eye drops.

After identifying the area to be « colored, » the surgeon uses a femtosecond laser to create a circular plane in the cornea, at a depth of about 250 microns. A lateral micro-incision then allows for the homogeneous injection of the pigment using a microcatheter.

The choice of shade depends on the desired result: blue, green, gray, or honey, with the possibility of gradients for a more natural look. The pigments used are biocompatible, sterile, and specially formulated for ophthalmic use.

The duration of the procedure is between 20 and 40 minutes for both eyes. Once the pigment is injected, no sutures are necessary: corneal healing occurs spontaneously within a few days. And above all, the result on the eye color is immediate.

Is there post-operative follow-up?

The ophthalmologist prescribes a local anti-inflammatory and antibiotic treatment for the first few weeks. A check-up also verifies the proper integration of the colored pigment and the absence of a corneal reaction.

The pigments remain stable over time. If the color changes, an adjustment is possible through a partial touch-up. In some cases, keratopigmentation can be partially reversible: part of the pigment can be removed by laser or diluted by re-intervention.

What are the limitations of keratopigmentation?

Aesthetically, keratopigmentation is intended for healthy people, without corneal pathology, severe dryness, or a history of recent intraocular surgery. But, as with any eye procedure, a complete assessment is essential, including:

• Corneal topography
• Pachymetry
• Endothelial examination
• Measurement of intraocular pressure

Medically, it also remains relevant in cases of visual or cosmetic reconstruction after injury. In this context, modifying the eye color can reduce aesthetic asymmetry or improve visual comfort by limiting light diffusion.

However, this surgery has no effect on vision or the transparency of the lens or retina; it only acts on the chromatic aspect of the cornea.

Comparison with other eye color changing methods

Several techniques have been explored to modify eye color:

• Colored contact lenses, non-invasive, are a temporary, reversible, and non-surgical solution. Their drawback remains long-term tolerance, especially with prolonged wear.
• Artificial iris implants, introduced intraocularly, generated media interest but are now strongly discouraged/contraindicated for safety reasons. Numerous complications have been reported.
• Iris depigmenting laser, which aims to lighten the natural color of the iris by destroying melanin, is still experimental and is not recommended as it can induce inflammation or an elevation of intraocular pressure.

Keratopigmentation thus appears today as a safer alternative, as it remains limited to the cornea and does not alter the internal structures of the eye.

Ethical and regulatory aspects of changing eye color

Aesthetic keratopigmentation raises ethical questions specific to purely cosmetic interventions on an organ as essential as the eye.

In France, it must be performed in a strict medical setting, by an experienced ophthalmologist surgeon. They must provide informed information to patients and complete traceability of the products used.

Furthermore, the use of approved ophthalmic-grade pigments is mandatory. Any pigment intended for skin tattooing or other uses is prohibited.

What to expect from keratopigmentation in the coming years?

The evolution of materials and techniques is opening up new perspectives.

Some laboratories are working on photostable pigments that can reproduce finer nuances or translucent effects similar to the natural iris. Others are developing devices allowing even more precise control of pigment diffusion, for a more homogeneous result.

Conclusion

Keratopigmentation is establishing itself as an innovative surgical technique in the modification of eye color.

Stemming from proven medical practices and now adapted to aesthetic demand, it offers an extraocular alternative to the highly criticized/now-contraindicated implants and depigmenting lasers.

To change your eye color permanently, it is important to go to a specialized ophthalmology clinic. This is what the Institut Voltaire offers with its keratopigmentation technique.