Viewing Cosmetic Eye Colour Change with a Different Lens

Dermot McGrath reports from the French Implant and Refractive Surgery Association (SAFIR) Annual Meeting

Although several techniques exist to permanently change eye colour, not all of them offer the same safety profile. Patients need to be made aware of the serious risks to their ocular health involved in some of the procedures currently being offered, warns Marc Muraine MD.

“There is a growing demand for procedures of this kind and a lot of media coverage about them. So while our natural reaction might be to simply say ‘no’ to all forms of cosmetic surgery, I believe it merits a response from the scientific community to inform our patients [objectively] and avoid some of the more dangerous options being promoted,” he said.

Dr Muraine identified four principal techniques to change eye colour: artificial iris implants, laser photocoagulation of the iris, corneal tattooing, and cosmetic contact lenses.

Although not approved in the European Union or the United States, artificial iris implants are widely advertised and promoted on the internet and are sometimes offered as part of package holiday deals, Dr Muraine said.

He recounted the experience of one patient who went to Tunisia and received the BrightOcular® (Stellar Devices) artificial iris. “It was pretty tragic but shows the risk with these implants— the patient was operated subsequently for bilateral corneal decompensation, which required a double transplant,” he said.

The case was not an isolated incident, Dr Muraine pointed out, citing a recent study by Corinne Dot MD et al, which reported that of 65 eyes of 33 patients who received artificial iris implants, only five eyes (7.7%) did not experience complications (JCRS, 46; 34–39). More than 92% of patients experienced at least one complication, with corneal decompensation in 78.5% of patients, glaucoma in 52.3%, and explantation in 81.5%.

“These implants are clearly best avoided—the only merit they have is they are reversible if we manage to take them out in time,” he said.

Techniques that use Nd:YAG laser photocoagulation to depigment the stromal iris are the most recent to effect permanent eye colour change, Dr Muraine said. He cited a recent prospective study by Pedro Ruiz MD in Barcelona, Spain, which included a series of 1,176 eyes that underwent photoablative cosmetic iridoplasty with up to nine years of follow up (Int Ophthalmol. 41, 1381–1393 [2021]).

“The procedure was shown to be safe and effective with no impact on intraocular pressure and a high level of patient satisfaction. The only notable complication was delayed and brief iritis, which was self-limited with routine topical treatment. Because the procedure depigments the iris, it is only possible to change the colour from dark to lighter shades, which might be a limitation for some patients,” Dr Muraine said.

Key advantages of the Nd:YAG laser procedure are that it does not involve any masking of the iris, and the pupil remains reactive. “It could potentially be offered to patients, but only under close medical surveillance and with appropriate preoperative psychological counselling, as the procedure is irreversible,” he added.

A better-known technique in France is the use of corneal tattooing or keratopigmentation, Dr Muraine said, who has himself successfully used it for therapeutic reconstruction of iris defects. Surgeons such as Francis Ferrari MD in Strasbourg and Jorge Alio MD, PhD in Alicante, Spain, have recently used femtosecond lasers to create a lamellar tunnel and inject biomedical pigments using a 27-gauge cannula to effect eye-colour change.

“Dr Alio published a study of the technique in seven patients and reported no complications and a high level of patient satisfaction with up to six months of follow up,” Dr Muraine explained.

Although the evidence to date seems encouraging, Dr Muraine said further study was needed, and additional long-term complications could not be ruled out.

“One potential problem with this technique is that the iridocorneal angle will be more difficult to analyse in the event of suspected glaucoma, or if there is a cataract to be operated, or another pathology of the anterior segment is present. The procedure is also not easily reversible, so the same rules apply in terms of psychological counselling for the patient before surgery,” he said.

In terms of cosmetic contact lenses, Dr Muraine said they have a very poor track record in scientific literature. He cited a prospective multicentre study at 12 French university hospitals by Arnaud Sauer MD that found of 256 patients included for contact lens-related microbial keratitis, 32 (12.5%) were cosmetic lens wearers (Acta Ophthalmol. 2011 Aug; 89(5): e439–42).

“The conclusion was that patients with cosmetic lenses are less likely to be instructed on appropriate lens use and basic hygiene rules. Consequently, they tend to experience more acute vision-threatening infection, with six times greater risk of infection,” he said.

“These implants are clearly best avoided—the only merit they have is they are reversible if we manage to take them out in time.”

Marc Muraine MD is Professor and Head of the Ophthalmology Department, Charles Nicolle Hospital, Rouen, France marc.muraine@chu-rouen.fr