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We were pleased to read the article by Pitz and associates on a pragmatic approach to the management of corneal tattooing.1 Though permanent colouring of unsightly corneal scars is considered an ancient form of treatment2 it has therapeutic value for a distinct group of patients.1–5 The authors are to be congratulated on their achievement in corneal tattooing by using the indigenous material injections (commercially available ink, thus no problem to obtain) into the corneal stromal lamellae in a modified manner.1 They have rightly pointed out that to date there is no optimal method of surgical technique for corneal tattooing. However, we feel it is always better to apply the colouring agents intralamellarly for two reasons: (1) it provides uniform distribution of the colour when applied on a smooth lamellar surface as against the irregular epithelium which is expected in these eyes; (2) it minimises the chances of development of an irritable eye which is expected when it is applied on the corneal surface.
Besides its therapeutic and cosmetic use for iris defects5 most of the time corneal tattooing is indicated in unsighted eyes with corneal scar.1–5 These eyes are bound to have an irregular surface. Thus, surface application of the dye, besides providing a patchy appearance, often is responsible for a surface irritant. Sometimes the lesion also requires an additional procedure of EDTA chelation as mentioned by the authors.1 Considering these facts, intralamellar application of the colouring agent for corneal tattooing should be an accepted procedure.