Iritis

New question to ask in uveitis diagnosis: do you have any tattoos?

I've been following an interesting set of cases on the relationship between tattoos and uveitis.  At first there was only one or two case studies, but recently a presentation at a John Hopkins University conference was more specific than before:

"Physicians who treat uveitis should ask patients about any tattoo changes. Some component of black tattoo ink may act as an environmental trigger—leading to the development of simultaneous bilateral ocular inflammation and elevation of tattooed skin."

"Though tattoo-associated uveitis is rarely reported, the likelihood of its presence is more common than the literature would suggest, according to Trucian Ostheimer, MD....Interestingly, he has seen seven such patients since beginning his fellowship with the Wilmer Ocular Immunology Service."

"Five of seven patients had bilateral non-granulomatous anterior uveitis—four with chronic and one with recurrent disease. Two patients had bilateral chronic granulomatous panuveitis. Initial visual acuity varied widely."

"Most of the patients had extensive tattoos, and many of these were multicolored. Interestingly, only portions of tattooed skin containing black pigment were affected and visibly raised."

“'Histologically, this can be classified as a foreign body or sarcoid-type reaction, and the differentiation of these two types of granulomas may be challenging and open to controversy,' Dr. Ostheimer said. 'The skin biopsies performed in two of our patients and in some prior reports displayed non-caseating inflammation in association with dermal tattoo pigment that I believe is consistent with, but not specific for, sarcoidosis.'"

“'It’s useful as part of your uveitic review of systems to ask patients who have uveitis about tattoo changes,' Dr. Ostheimer continued. 'It is purely speculative, but I think it is reasonable to conclude that there may be some component of black tattoo ink that acts as an environmental trigger—leading to the development of simultaneous bilateral ocular inflammation and elevation of tattooed skin.'”