Endogenous Fungal Endophthalmitis Following Eyebrow Tattooing: A Case Report

This case report describes a rare instance of bilateral endogenous fungal endophthalmitis in a 50-year-old healthy female patient, following a facial tattooing procedure. Initially misdiagnosed as iritis in the right eye due to presenting symptoms of blurred vision and ocular pain, the patient's condition worsened following treatment with corticosteroids. Ophthalmic examination revealed severe vitreous opacity in the right eye and a yellowish-white lesion in the inferonasal retina of the left eye. Metagenomic sequencing of the vitreous fluid confirmed infection with Aspergillus fumigatus. The patient underwent pars plana vitrectomy with silicone oil tamponade, retinal laser photocoagulation, and intravitreal voriconazole injection in the right eye. Both eyes received multiple intravitreal voriconazole injections, supplemented with systemic antifungal therapy. Postoperatively, the visual acuity in the right eye improved, and the left eye gradually recovered to 20/35. Serial optical coherence tomography follow-up of the left eye documented the progressive detachment of the fungal embolus from the retinal lesion into the vitreous cavity. This case highlights that traumatic cosmetic procedures, such as eyebrow tattooing, can be a potential risk factor for endogenous fungal infection. In cases of atypical uveitis, early etiological investigation is crucial to avoid misdiagnosis and inappropriate treatment. Dynamic imaging provides valuable evidence for assessing the efficacy of antifungal therapy and determining prognosis.