Isolated tattoo-associated uveitis without systemic sarcoidosis: A systematic review of case reports

We systematically review and characterize cases of tattoo-associated uveitis without systemic sarcoidosis, focusing on clinical presentation, diagnostic workup, management, and outcomes. We conducted a comprehensive literature search across PubMed, Google Scholar, Scopus, Web of Science, and Embase from 1969 to April 2025, following PRISMA guidelines. Eligible studies included case reports and series documenting tattoo-related uveitis in the absence of confirmed systemic sarcoidosis. Thirty-three studies encompassing 44 patients (86 eyes) were included. Most patients were male (75 %), with a mean age of 31.9 ± 11.5 years. Tattoos were typically permanent (97.7 %), extensive in size (61.4 %), and placed on the arms (77.3 %), with black pigment most common (61.3 %). Skin inflammation was reported in 88.6 % of patients, typically preceding or coinciding with uveitis onset. Anterior uveitis (52.3 %) and bilateral involvement (95.5 %) were predominant. Common findings included anterior chamber inflammation (56.8 %), vitritis (38.6 %), and cystoid macular edema (27.3 %). No significant associations were found, except between number of tattoos and uveitis laterality (p = 0.046). Work-up frequently involved chest imaging (72.7 %), skin biopsy (88.6 %), and infectious screening. Management included corticosteroids (70.5 %), immunosuppressants (38.6 %), and tattoo excision (15.9 %). Inflammation was controlled in 70.5 %, though 50 % required long-term corticosteroids and 15.9 % required intraocular pressure management. Tattoo-associated uveitis is an emerging entity that can mimic sarcoidosis, often presenting with delayed ocular inflammation and concurrent skin findings. Clinicians should inquire about tattoos in uveitis patients and monitor for potential systemic involvement. Multidisciplinary evaluation and tailored treatment, including immunosuppression or tattoo removal, may be needed to achieve disease control.