Tech Talk #25: From Eyeliner to the Emergency Room

How a simple procedure landed this client in the hospital, unable to see.

This report comes from a trainee cosmetic tattooist who had an eyeliner treatment by a trainer. If you are a cosmetic tattooist, you need to read this!

Quick Facts:

• Trainer had only been trained herself a few months earlier
• Topical anaesthetic got onto both eyes (they had not been pre-treated with drops to protect them)
• 'Client' (trainee cosmetic tattooist and a nurse) experienced severe pain
• At the completion of the treatment, it was noticed that both the client's pupils were dilated. No first aid or support was provided.
• Client went outside in normal sunlight to go to doctor and was directed to the hospital emergency department
• Client became temporarily blind, with her eyesight still recovering weeks later
• Client was diagnosed with corneal abrasions (presumably from cleaning)
• Lawyers for the trainer quickly offered some compensation in exchange for a deed of release

Lesson Learned:

• Train with a reputable and experienced trainer/organisation
• Epinephrine (adrenaline) in topical anaesthetic can cause rapid pupil dilation
• Topical anaesthetics must come from a compounding pharmacy experienced in anaesthetics for cosmetic tattooing (few are)
• Always prepare eyes with an eye lubricant such as Celluvisc®
• DO NOT apply topical anaesthetic to the mucous membrane at the edge of the eyelid. It will get onto the eye
• IF topical anaesthetic gets on the eye, STOP and follow the procedure below

Emergency Response:

1. First, check for dilation (enlargement) of the eye pupil/s. This will cause sensitivity to light and vulnerability to optic nerve damage.
2. If dilated, immediately get the client into a darkened room. If that is difficult, ensure their eyes are closed and cover their head with a large towel or blanket
3. Wash the eyes with sterile eye wash (which you should have available), or fresh clean tap water
4. If dilated, sit the client in a darkened room for at least one hour and until, hopefully, any discomfort has gone and the pupils respond normally to light. The last part is really important to avoid eye damage including permanent vision loss
5. If the client has any ongoing discomfort or blurred vision, tell them to go to a nearby doctor (best to have a relationship with a doctor to send clients to in the event of an emergency)
6. Otherwise, if all is OK and the pupils have returned to normal, send the client home (check in on them via call or text later that day or the next to ensure they are not experiencing any issues).

Haven't got Eye Drops? Get some here!

While this incident did not involve THink Aesthetics or THink MBC, we were put in contact with the trainee cosmetic tattooist / client who experienced this.

This Tech Talk has been produced with the knowledge and permission of the client who was affected, with the goal of education and prevention.

For topical anaesthetic supply we recommend Keperra Compounding Pharmacy, specialists in topical anaesthetics for cosmetic tattooing: https://compoundingpharmacy.com.au/