Dozens diagnosed with rare tattoo-related vision loss
Researchers have uncovered 40 cases of tattoo-related uveitis throughout Australia. (Getty Images: Olga Pankova)
When chef Nelize Pretorius noticed her vision blurring—first in one eye, then the other—doctors initially thought she had conjunctivitis.
But when tests came back negative, her GP and hospital specialists struggled to identify the cause of the worsening eye inflammation.
“I could hardly see,” she said. “I was losing my vision and nobody was able to tell me why.”
The culprit wasn’t her eyes at all—it was a tattoo on her back she had gotten years earlier.
Her condition, known as tattoo-associated uveitis, can lead to permanent vision loss, glaucoma, and lifelong treatment with immunosuppressant medications.
“You get a tattoo, and you think the risk is that you might regret it later in life,” Ms Pretorius said. “[The real risk is] you could potentially lose your vision.”
Although previously thought to be extremely rare, research published in Clinical and Experimental Ophthalmology has documented 40 new cases in Australia, doubling the number of cases reported worldwide since 2010. The study, led by Australian researchers, suggests the condition may be more common than previously believed, and experts are calling for more investigation.
Eyes in the Immune “Crossfire”
Josephine Richards, the ophthalmologist who treated Ms Pretorius, has extensive experience with immune-related eye diseases. Uveitis occurs when the immune system mistakenly attacks parts of the eye, often linked to autoimmune conditions such as arthritis. Early symptoms include blurred vision, light sensitivity, and pain, and if untreated, uveitis can cause glaucoma or permanent vision loss.
“We do not know why the eye gets caught in the crossfire,” Dr Richards said. “There is something about the immune reaction that targets the eye.”
In recent years, Dr Richards has seen a rise in cases linked to tattoo ink, sometimes appearing years after the tattoo was done. Tattoos causing uveitis may appear slightly raised and inflamed.
“I only became aware of it about four or five years ago, and then once I was aware, I had all these patients suddenly,” she said. At a conference of ophthalmologists focused on eye inflammation, specialists realized many young tattooed patients were presenting with the same issue.
Since the last conference in November 2025, Dr Richards noted four more cases in Western Australia alone, with other states likely seeing additional cases.
Most patients in the study required long-term immunosuppressive treatment, and only three maintained full vision throughout therapy. Ms Pretorius continues to use steroid eye drops and has spent thousands of dollars on treatment, managing periodic flare-ups with Dr Richards.
“What really worries us is that we’re just not managing to get these people off the drugs,” Dr Richards said. “Usually with an immune disease, we treat for two years and then slowly wind back treatment and hope that the person is okay off it. But mostly, we’re not able to do that.”
Investigating the Cause
Researchers have yet to pinpoint why certain tattoos trigger this reaction. The study found black ink was most often associated with inflammation, though pink and red inks were linked in rare cases. Symptoms typically appeared one to two years after the tattoo, but one case occurred 35 years later.
Some patients had tattoos done overseas, including in Bali, complicating efforts to identify the ink components responsible. Dr Richards emphasized the need to determine what in the dyes triggers the reaction, saying, “I hope we will understand why it’s happening and be able to identify what it is about the dyes that are triggering it and take those out of the mix.”
Despite the rise in cases, Nicole Carnt, an optometrist at the University of New South Wales, noted that tattoo-associated uveitis remains rare given that 20–30% of Australians have at least one tattoo.
“So many people have tattoos and don’t have any problems,” she said. “So what is triggering this in some people?”
Drs Carnt and Richards suggested genetic susceptibility and the microbiome may play a role. Dr Richards compared the condition to sarcoidosis, an immune disease where inflammatory cells form red, swollen clusters in the body. Biopsies of inflamed tattoos often resemble these sarcoidosis patterns.
Moving Toward Safer Tattoos
Researchers recognize it’s unlikely people will stop getting tattoos, especially for a rare condition with delayed onset. Dr Richards said her focus is on identifying harmful components in ink to make tattoos safer.
Ms Pretorius reflected on her own experience: “I don’t know if 18-year-old Nelize would have listened, but 33-year-old Nelize certainly would.”
Education is also key. Dr Richards aims to ensure patients and doctors recognize the signs of tattoo-associated uveitis for timely referral and treatment.
“It wouldn’t change the decision for many people. Some of my tattooed patients on immunosuppression still get tattoos because it’s important to them,” she said. “But I would like people to at least know.”
Ms Pretorius considers herself fortunate that her case was identified early. “It’s lucky that Dr Richards knew about it, because if she wasn’t there, I may still not know what the issue is. A few people have lost their vision permanently, so relatively speaking, I came off pretty good.”
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