Light and Electron Microscopic Findings with Permanent Eyeliner

Pathologic studies were performed on two specimens of eyelid that had been treated with permanent eyeliner (tattooing with ferrous oxide), one specimen excised four days after injection of the pigment, and the other obtained 12 months later. Each patient had undergone an ectropion repair of the lower eyelid that provided the specimen. The specimen studied four days after injection revealed by light microscopy scattered pigment granules within the epidermis and fine granules and small aggregates dispersed within the dermis. No acute or chronic inflammatory cells were observed in relationship to the deposits. The specimen obtained 12 months after eyeliner injection was studied by both light and electron microscopy. No pigment particles were observed within the epidermis, but rather there were coarse clumps of granular material in the dermis. Apart from scattered mast cells, which occasionally contained fine granules, and apart from the macrophages which appeared to have ingested the pigment granules, no other acute and chronic inflammatory cells were found. Electron microscopy demonstrated that while most of the granular material had been phagocytosed by macrophages, occasional granules were found in small dispersions within the cytoplasm of mast cells and fibroblasts of the dermis. Minimal migration of pigment within macrophages occurred to locations around lymphatic channels and within the superficial orbicularis muscle connective tissue.