Tattoo Granuloma with Uveitis

A patient presented with painful decreased vision in the right eye for 3 weeks. He was found to be in pupillary block with 360* posterior synechiae and anterior chamber cell in both eyes. A laser peripheral iridotomy was performed with relief of pain and elevated pressure. Topical anti-inflammatory drops were started with adequate control of his inflammation. Infectious and inflammatory lab workup was unrevealing. Optical coherence tomography (OCT) demonstrated mild cystoid macular edema. Fluorescein angiography demonstrated leakage both optic discs and ICG revealed possible choroidal granulomas. The patient noted that symptoms began at the same time as nodular inflammation of his extensive black tattoos on both arms. Punch biopsy of his skin revealed granulomatous reaction around tattoo pigment. CT chest was negative for evidence of sarcoidosis. Patient was referred to rheumatology for further evaluation of possible underlying sarcoidosis and consideration of immunomodulatory therapy. This presentation reviews the pathophysiology, risk factors, treatment methods, and classification of tattoo uveitis.

Presentation Date: 04/29/2021

Issue Date: 05/07/2021