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While some consumers turn to products marketed as eye color changing drops in search of their preferred shade, others pursue an even more invasive option, reportedly pay thousands of dollars for surgery to change their eye color.

Amid concerns from eye doctors, patients have said the procedure, known as keratopigmentation or eye tattooing, is worth the potential risks.

The process involves “tattooing the cornea, the front windshield of the eye,” said Allison Coombs, DO, MS, director of oculofacial plastic surgery at Northwell Health’s Manhattan Eye, Ear & Throat Hospital and Lenox Hill Hospital in New York City. MedPage today.

While this type of procedure has been used for many years for patients with certain conditions — such as being born without the colored part of the eye and having light sensitivity as a result — in recent years, patients have been “doing more” in aesthetics, Coombs said .

Ophthalmologists have been more comfortable accepting the risks for patients with medical indications, she noted, but this is not the case for those who want the procedure for aesthetic reasons.

One thing to keep in mind is that most of the cornea may be covered by a procedure for aesthetic reasons, rather than just part of the eye that may be targeted for a procedure for medical reasons, Coombs explained.

Risks associated with the procedure include sight-threatening infections and inflammatory problems, as well as pigment migration and quality problems such as discoloration, fading, or color change over time.

Ultimately, there is “not enough data as an ophthalmology community for us to say whether this is safe or not,” Coombs said.

In fact, the American Academy of Ophthalmology (AAO) issued a statement earlier this year that warned of the dangers associated with eye color changing procedures that they trended on social media.

“The natural cornea is crystal clear and shows the color of the iris underneath it inside the eye,” the AAO explained. In keratopigmentation, the process involves “using a needle or a laser to create space in the cornea itself, into which a color pigment is injected, permanently changing the cornea from clear to opaque and covering the natural iris color inside.”

The organization also highlighted a variety of risks with the procedure, including:

• Damage to the cornea that can lead to clouding, distortion, fluid leakage and loss of vision
• Light sensitivity
• Reaction to the dye, which can cause inflammation, uveitis, or growth of blood vessels in the cornea
• Bacterial or fungal infection, which can cause corneal scarring and vision loss
• Uneven distribution of the dye
• Leakage of the dye into the eye
• The color fades due to the color moving or leaking into the eye

“I don’t think these surgeries carry any risk,” JoAnn Giaconi, MD, a clinical spokeswoman for the AAO, said at the time. “No surgery is risk-free. With purely cosmetic surgeries on the eye, it’s just not worth the risk when it comes to your good vision.”

The AAO also pointed to potential risks associated with iris implant surgery, which is approved by the FDA, but for individuals who are missing part or all of the colored part of the eye due to an injury or birth defect. “Patients who have the procedure for medical reasons are also at risk of complications from implant surgery, but the benefits of getting an iris may outweigh their risks,” the organization said.

Apart from operations, the AAO has warned about products marketed as eye color-changing drops, noting that manufacturers claim the eye drops contain an ingredient that adjusts natural levels of melanin in the iris.

But there is “nothing approved by the FDA that can actually do this,” Alina Djougarian, MD, an ophthalmologist at Northwell Health, previously told MedPage today. Claims such as a “brown eye turning blue” are “false advertising,” she said.

She explained that eye pigment is genetically determined, and depigmentation can lead to severe inflammation or increased pressure in the eye, which can then lead to glaucoma or other serious conditions that can cause blindness.

Coombs said information about eye color change procedures circulating online and on social media is “extremely concerning.”

“For people looking for that cosmetic gain, the only people we hear from have a positive experience, but we just don’t have enough data (to say) ‘take your healthy eyes and change the color,'” she added.

The AAO has stated that the safest way to change eye color is to use colored contact lenses, which should only be worn as prescribed, dispensed and fitted by a qualified ophthalmologist.

Coombs agreed. Keratopigmentation for aesthetic purposes is both “risky and permanent,” she said. “It is impossible to un-tattoo the corneas.”