Eye kerato-pigmentation: a growing trend that is not without risks1
Press release from the French Academy of Medicine
June 18, 2025
Eye color is given by the genetically-dependent shade of the iris. It is not possible to alter this intraocular structure to change its pigmentation. However, a surgical technique, called kerato-pigmentation, can permanently change the eye color by placing pigments in the thickness of the cornea.
This procedure, initially intended to correct post-traumatic unsightly after- effects of the eye, have become increasingly popular over the last 10 years for aesthetic reasons (1).
Kerato-pigmentation is performed in an ophthalmic surgery operating room under strict aseptic conditions, without the need for hospitalization and after instillation of anesthetic eye drops. The femtosecond laser, which is used in ophthalmology centers performing surgery for vision disorders, allows an annular tunnel to be created in the thickness of the cornea (2). The sterile biocompatible pigment of the color chosen by the patient, is then injected into this tunnel. No sutures are required. Antibiotic eye drops are instilled and, following the operation, patients are asked to avoid getting water in their eyes for one month.
Beyond its aesthetic weaknesses (the color of the pigments obtained is too uniform and may fade over time; the color of the eye not appearing natural due to its too homogeneous appearance and the persistence of the initial color of the eye around the cornea), this technique, whose effects are considered definitive, is not without risks, or immediate or future consequences, of which those who use it must absolutely be informed (3).
While strict adherence to perioperative asepsis and post-operative advice can prevent the occurrence of infectious keratitis, there is, as after any corneal surgery, a risk of dry eye and glare after the procedure. A loss of endothelial cells, which can lead to a loss of corneal transparency with age, has been described (4). The fixed diameter of the pupil, determined by the limits of pigmentation, may also hamper the analysis of intraocular structures during subsequent ophthalmological examinations and the treatment of any lesions, particularly in the retinal periphery. The presence of metallic compounds in some pigments can pose a risk when performing magnetic resonance imaging.
Considering the rise of cosmetic kerato-pigmentation of the eyes for esthetic purpose whose potential negative consequences should not be underestimated in the short, medium and long term given the limited experience to date, the French Academy of Medicine underlines :
– The importance of providing applicants with a preliminary information document, drawn up by the relevant learned societies, specifying the consequences and risks of this eye color changing technique for purely aesthetic purposes.
– The risks of undergoing treatment abroad, at attractive prices, but without any guarantee of the practitioners’ skills, and therefore of the quality of the medical handling, with an increased possibility of complications.
– The contrast between the rise of this practice and the difficulties faced by people residing in France in obtaining a standard consultation appointment with an ophthalmologist.
References
– Hasani H, Es’haghi A, Rafatnia S, Alilou S, Abolmaali M. Keratopigmentation: a comprehensive review. Eye (Lond). 2020 Jun;34(6):1039-1046.
– Alafaleq M, van Haselen R, Ferrari F. The safety and effectiveness of a novel annular keratopigmentation technique; a cross-sectional survey of patients. BMC Ophthalmol. 2023 Jun 27;23(1):292.
– Zegers RHC. The ever ongoing cosmetic quest to change eye colour. Acta Ophthalmol. 2025 May;103(3):357-362
– Alio J., Sanginabadi A., Hojabr A.T., et al., Femtosecond laser-assisted keratopigmentation outcomes for pure cosmetic purposes, Am J Ophthalmol Case Rep, 2025; Mar 7;38:102297.
CONTACT PRESS : Virginie Gustin +33 (0)6 62 52 43 42 virginie.gustin@academie-medecine.fr
ACADÉMIE NATIONALE DE MÉDECINE, 16 rue Bonaparte – 75272 Paris cedex 06 Site : www.academie-medecine.fr / Twittcadm
1 Press release from the Academy’s Rapid Communication Platform.
