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

Jihyun Yoon; Ah Young Kim; Roo Min Jun; Kyung Eun Han

doi:10.3341/jkos.2020.61.2.146

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Yoon, Kim, Jun, and Han: The Effect of Eyeliner Tattoo on Meibomian Gland Dysfunction and the Ocular Surface

Original Article

Journal of the Korean Ophthalmological Society 2020; 61(2): 146-152.

Published online: 18 February 2020

DOI: https://doi.org/10.3341/jkos.2020.61.2.146

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

Jihyun Yoon, MD¹, Ah Young Kim, MD², Roo Min Jun, MD, PhD³, Kyung Eun Han, MD, PhD¹

¹The Institute of Ophthalmology and Optometry, Department of Ophthalmology, Ewha Womans University Mokdong Hospital, Ewha Womans University College of Medicine, Seoul, Korea.

²Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.

³The Institute of Ophthalmology and Optometry, Department of Ophthalmology, Ewha Womans University Seoul Hospital, Ewha Womans University College of Medicine, Seoul, Korea.

Address reprint requests to Kyung Eun Han, MD, PhD. Department of Ophthalmology, Ewha Womans University Mokdong Hospital, #1071 Anyangcheon-ro, Yangcheon-gu, Seoul 07985, Korea. Tel: 82-2-2650-5153, Fax: 82-2-2654-4334, hkeoph@gmail.com

Received 2 September 2019 Revised 18 October 2019 Accepted 22 January 2020

The Korean Ophthalmological Society

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

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 (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.

Keywords: Dry eye syndrome, Eyeliner tattoo, Meibomian gland, Tear film lipid layer thickness

Figures and Tables

Figure 1

The area of the central two-thirds on upper tarsal conjunctiva, in which meibomian glands were best visible, was selected through drag and drop with mouse (A). Then, the area of meibomian gland dropout area within the aforementioned area was selected in the same manner (B). The ratio of the two area was calculated.

Figure 2

Distance between the tattoo pigment and the meibomian gland orifice was scored and was recorded as the tattoo score (mm). In each right (A) and left eye (B), the blue arrows on the top indicates tattoo pigment, and the yellow arrows at the bottom indicates meibomian gland orifice. In this case, the distance or tattoo score was measured as 1.0 mm in each eye.

Figure 3

Meibomian gland (MG) loss of eyeliner tattoo group and tear film lipid layer thickness (LLT) of eyeliner tattoo group. (A) MG loss was significantly correlated with the tattoo score (r_s = −0.563, p = 0.023; Spearman correlation test). (B) LLT was significantly correlated with the tattoo score (r_s = 0.567, p = 0.022; Spearman correlation test).

Table 1

Demographics and clinical data of the study subjects

Values are presented as mean ± standard deviation unless otherwise indicated.

NA = not available; MG = meibomian gland; MCJ = mucocutaneous junction; TBUT = tear film break-up time; OSDI = ocular surface disease index.

^*Fisher's exact test is not able since the lid margin of all subjects is normal in both groups; ^†Fisher's exact test was used. p < 0.05 were considered statistically significant; ^‡Mann-Whitney U test was used. p < 0.05 were considered statistically significant; ^§for meibum quality, the number of the subjects of tattoo group was 14, not 16, because of omitted record.

Table 2

Correlation between upper eyeliner tattoo score and other indices

NA = not able; MG = meibomian gland; MCJ = mucocutaneous junction; TBUT = tear film break-up time; OSDI = ocular surface disease index.

^*r_s = Spearman correlation coefficient; ^†NA = Spearman correlation test is not able since the lid margin of all subjects is normal in tattoo group; ^‡p < 0.05, which were considered statistically significant.

Notes

This study was presented as a poster at the 118th Annual Meeting of the Korean Ophthalmological Society 2017.

This work was supported by the National Research Foundation of Korea (NRF) grant funded by the Korea government (MSIT) (No. NRF-2017R1C1B1011577).

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