Magnetic Resonance Imaging and Keratopigmentation: A Systematic Review and Ex Vivo Study of Complications and Adverse Events

MRI appears safe in patients with keratopigmentation using iron oxide-free inks, which are the most commonly used. In contrast, iron oxide-containing inks can induce MRI artifacts that inhibit ocular assessment without affecting brain visualization. Under the influence of the magnetic field, their pigments may also migrate, potentially causing ocular pain, central corneal involvement, or weakening of corneal biomechanical integrity. For corneal tattooing, we recommend using carbon-based inks for black pigmentation and one of the iron oxide-free inks for colored keratopigmentation.