The ever ongoing cosmetic quest to change eye colour.

Purpose: To provide a historical overview of the various efforts to change eye colour for purely cosmetic reasons, along with the associated potential risks and harms.

Methods: Literature and online search.

Results: Eye drops containing adrenaline were used during World War II on involuntary inmates of concentration camp Auschwitz-Birkenau. Prostaglandin drops, used in glaucoma therapy since 1996, can increase iris pigmentation as an undesired side effect. Commercial drops, available since 2011, are not effective and potentially dangerous. Iris implants, commercially available since 2011, led to serious complications like corneal decompensation, uveitis and glaucoma, and for this reason, implants had to be removed, leaving some patients almost blind. Also commercially in use since 2011 are laser treatments to make brown eyes blue. Among the possible complications are anterior uveitis and (pigmentary) glaucoma. Corneal tattooing has existed for almost 2000 years. Complications of modern, intrastromal keratopigmentation include corneal perforation, bacterial infection, allergic or toxic reaction to pigment, migration of pigment, and functional complications like visual field limitation and light sensitivity. Personal identity and self-esteem are likely contributing factors to undergo this potentially harmful cosmetic eye surgery. In addition to the earlier discussed complications, the artificial layer of colour can obscure ocular pathology of the cornea or iris. As the majority of individuals undergoing these procedures are relatively young, problems may arise in the future when they will need cataract or other eye surgeries.

Conclusion: Permanently changing eye colour in healthy eyes for purely cosmetic reasons is a risky procedure.