When chef Nelyse Pretorius felt her vision become blurry, it was first in one eye, then the other. It was dismissed as conjunctivitis.
But with negative swab results, her GP and hospital doctors struggled to understand what was causing the inflammation in her eyes to gradually worsen.
“I was almost blind,” she said.
“I was losing my eyesight, but no one could tell me why.”
The cause had nothing to do with the eye itself, but rather a tattoo that Pretorius had had on his back for years.
This condition, known as tattoo-associated uveitis, can cause permanent vision loss, glaucoma, and patients may require lifelong immunosuppressive medications.
“I think there’s a risk when you get a tattoo that you might regret it later,” Pretorius says.
”[The real risk is] You may lose your eyesight. ”
Nellie Pretorius has spent thousands of dollars on treatments to prevent her vision from deteriorating. (Provided by: Nellis Pretorius)
Tattoo-related uveitis was thought to be extremely rare, but a study was published in a journal. Clinical and experimental ophthalmology Forty new cases of the disease have been recorded in Australia, doubling the number of published cases detected worldwide since 2010.
The study, conducted by an Australian team, suggests that this complication, while still rare, may be more common than we think, given the number of people who get tattoos.
Experts are calling for Further research is needed to understand and limit vision-threatening diseases.
Eyes in the immune “crossfire”
Josephine Richards, the ophthalmologist who treated Pretorius, is an expert in immune diseases.
Working in the field of eye inflammation, she has seen many cases of uveitis, a dangerous condition in which the immune system begins to damage the eye.
This can be a complication of autoimmune arthritis and many other autoimmune diseases in which the immune system mistakenly attacks parts of the body.
Nelise’s eyesight has deteriorated and she is no longer able to work as a chef. (Provided by: Nellis Pretorius)
Early symptoms of uveitis include blurred vision, photosensitivity, and pain, which, if left untreated, can lead to glaucoma and permanent vision loss.
“We don’t know why the eyes get caught in the crossfire,” Dr. Richards said.
“There’s something about the immune response that targets the eyes.”
However, in recent years, Dr. Richards has Cases of uveitis caused by injected tattoo ink – sometimes occurring long after getting the tattoo.
Doctors can tell that your uveitis is caused by a tattoo because the tattoo looks slightly raised and inflamed.
“I only became aware of it four or five years ago and all of a sudden I had more patients,” she said.
And she wasn’t the only eye doctor to see this.
At a meeting of ophthalmologists interested in eye inflammation, experts noted that many were being referred cases of tattooed young people with the same problem.
“So we said, ‘Okay, we’d better look into this and see if it’s becoming more common.'”
“And right after the last conference, [in November 2025] There are four more cases in Western Australia. Other states are probably getting more, too. ”
In a recently published study, most cases of tattoo-related uveitis required long-term treatment, including immunosuppression, and only three patients had no vision loss during treatment.
Pretorius continues to use steroid eye drops and has spent thousands of dollars on treatments. She continues to communicate with Dr. Richards to deal with periodic flare-ups.
“What we’re really concerned about is that we’re not getting these people off drugs,” Dr. Richards said.
“Typically, with immune diseases, we treat for two years and then gradually reduce the treatment and hope that the patient is okay with stopping the treatment. But in most cases we cannot reduce the treatment.”
Why is this happening?
It’s unclear exactly why some tattoos cause this reaction, but new research provides some clues.
Most of the patients with tattoo-related uveitis studied in this paper had black ink tattoos that appeared to be causing the inflammation, but one case each of pink and red ink tattoos were also recorded.
In most cases, the tattoo was completed a long time ago, on average around 1-2 years, but in some cases it was as long as 35 years after the tattoo was completed.
Dr Richards said some, but not all, got their tattoos abroad, such as in Bali.
This makes it especially difficult for researchers to figure out what in the ink might cause this reaction.
“It’s very difficult to find out what dye was used,” she says.
Dr Richards said it was important to be able to determine why the dye caused the reaction.
“We hope that we can understand why it’s happening and identify the dyes that are causing it and remove them from the mix,” she said.
Black ink appears to be used in most cases of tattoo-related uveitis, and it is also the most commonly used ink. (Getty Images: Rawpixel)
Despite an increase in cases over the past few years, it remains a rare condition given that around 20 to 30 per cent of Australians have at least one tattoo, said Nicole Karnt, a vision scientist at the University of Sydney who was not involved in the study.
“There are millions of people who have tattoos and don’t have any problems,” she says.
“So what is causing this condition in some people?”
Dr. Karndt and Dr. Richards suggested that genetic susceptibility and the microbiome may be involved.
Dr. Richards said the condition is very similar to an immune disease called sarcoidosis. Areas where inflammatory cells gather around the body and form red, swollen masses.
“When you do a biopsy of an inflamed tattoo, it looks almost identical to what you see on the chest with sarcoidosis,” she says.
“Every immune disease has some genetic predisposition, some way your immune system deals with the world, and then you’re exposed to something that makes you feel sick,” she added.
Dr. Richards noted that people with a familial risk for immune diseases such as sarcoidosis may be more likely to develop this tattoo-related infection.
How to make your tattoo safer
The researchers I’m well aware that it’s unlikely to convince people to stop getting inked, especially for a rare disease that might pop up in a few years.
“So many people get tattoos, and I think it’s very difficult to stop people from getting tattoos,” Dr. Richards said.
Even Pretorius wasn’t sure if his younger self would agree.
“I don’t know if an 18-year-old Nellie would listen, but a 33-year-old Nellie definitely would,” she said.
Instead, Dr. Richards wanted to focus on what is in the ink that causes this problem and make sure it can be removed.
“If you can make it safer, that’s going to be the best outcome for everyone.”
Dr. Kernt agreed, suggesting that more research is needed to understand what makes some people vulnerable and others not.
Dr. Richard is also working to make more people and their doctors aware of the disease so they can be referred and treated sooner.
“For many people, that won’t change their decision. Some of my tattooed patients on immunosuppressive therapy continue to get their tattoos because it’s so important to them,” she said.
“But I want people to at least know.”
Pretorius feels lucky that the situation hasn’t worsened, despite his symptoms, which he jokes he’s making up.
“I think my case in particular was one of the first cases Dr Richards took in Perth,” she said.
“I was really lucky that she knew that. If she hadn’t been there that day, I might not have known what the problem was yet.
“There are some people. [with tattoo-associated uveitis] Since I lost my eyesight permanently, I was able to do relatively well. ”