March 23, 2026 8 min read

Contraindications to FLAAK Keratopigmentation

Q: I have keratoconus: can I undergo FLAAK keratopigmentation?

No, keratoconus is an absolute contraindication to FLAAK keratopigmentation. This progressive corneal deformation compromises the creation of a regular corneal tunnel and drastically increases the risk of postoperative complications, particularly induced ectasia. Yoni Gozlan, M.D. will only offer this technique if your cornea is stable and shows no signs of keratoconus or ectasia.

Q: What about corneal scars from a previous trauma?

Old corneal scars represent contraindications to FLAAK keratopigmentation depending on their location and density. If the scar is in the central optical zone or significantly alters the stromal architecture, keratopigmentation cannot be offered. A consultation with Yoni Gozlan, M.D. will determine whether your situation presents a definitive contraindication or whether prior treatment (graft or cross-linking) is an option.

Q: Does dry eye contraindicate FLAAK keratopigmentation?

Mild to moderate dry eye is not an absolute contraindication to FLAAK keratopigmentation, but it requires pretreatment to optimize postoperative outcomes. Severe dry eye is a relative contraindication that may be resolved after intensive treatment (punctal plugs, hyaluronate, anti-inflammatory agents). Dr. Gozlan evaluates this condition during the initial consultation.

Dr Yoni Gozlan

Ophthalmic Surgeon — FLAAK Keratopigmentation Specialist

SFO · SAFIR member · Paris 16th

The contraindications to FLAAK keratopigmentation are clinical situations in which this eye color change technique through intracorneal pigmentation cannot be offered, or requires a thorough preliminary evaluation. Yoni Gozlan, M.D., Ophthalmic Surgeon specializing in FLAAK keratopigmentation in Paris, explains the exclusion criteria, incompatible corneal pathologies, and situations that contraindicate this procedure to ensure the safety and effectiveness of the outcome.

What Is a Contraindication to FLAAK Keratopigmentation?

A contraindication to FLAAK keratopigmentation is a medical or anatomical situation that renders a patient ineligible for this technique, or significantly increases the risk of complications. FLAAK keratopigmentation relies on the creation of a corneal tunnel using a femtosecond laser and the deposition of a colored pigment within the corneal stroma. For this reason, anything that compromises corneal integrity, optical transparency, or predictable healing constitutes a significant limitation.

Yoni Gozlan, M.D. performs a comprehensive ophthalmic assessment during the initial consultation to identify these situations and offer this eye color change procedure only to safe candidates.

Contraindications to FLAAK Keratopigmentation Related to Corneal Pathologies

The most common contraindications to FLAAK keratopigmentation involve the structure of the cornea itself. Certain corneal pathologies represent absolute contraindications to FLAAK keratopigmentation:

Keratoconus and corneal ectasia: These progressive corneal deformities make it impossible to create a regular tunnel. Intracorneal pigmentation could worsen the ectasia or lead to poor healing.
Previous corneal scars: A history of chemical burns, severe corneal trauma, or herpetic infection with scarring alters the stromal architecture and contraindicates the procedure.
Central corneal opacity: Any opacity in the optical zone (pupillary zone) must be treated first or contraindicates the procedure, as pigment cannot be deposited on an opaque cornea.
Hereditary corneal dystrophy: Granular, lattice, or macular dystrophies increase the risk of postoperative complications.
Active herpetic keratitis: Any ongoing herpetic infection or recent history of corneal herpes is a temporary or permanent contraindication depending on severity.

Dr. Gozlan identifies these contraindications to FLAAK keratopigmentation of corneal origin during the preoperative assessment to ensure the safety of each patient.

Contraindications to FLAAK Keratopigmentation Related to Corneal Thickness

Among the contraindications to FLAAK keratopigmentation, corneal thickness is a critical parameter in keratopigmentation. The tunnel must be created without compromising the biomechanical integrity of the cornea. Patients with a cornea that is too thin are therefore contraindicated:

Pachymetry below 450 µm: A thin cornea increases the risk of induced ectasia and scarring complications. Yoni Gozlan, M.D. systematically evaluates this measurement using corneal topography.
History of refractive surgery: Patients who have undergone LASIK or PRK have a thinned cornea. Depending on the previous ablation depth, keratopigmentation may be contraindicated or require very cautious analysis.
Suspected latent (forme fruste) keratoconus: Certain topographic indices (cone decentration, asymmetry) suggest subclinical keratoconus, a contraindication that must be respected.

These pachymetric contraindications to FLAAK keratopigmentation are evaluated by topography and pachymetry during each initial consultation.

Ocular Diseases and Contraindications to FLAAK Keratopigmentation

Certain systemic or local conditions reduce candidacy or require specific management before considering FLAAK keratopigmentation:

Severe dry eye: Significant dry eye syndrome slows healing and increases postoperative inflammation. Pretreatment may be offered.
Decompensated glaucoma or iridectomy: Although the pigment is deposited in the cornea and not in the iris, abnormalities of the iridocorneal angle or chronic ocular hypertension contraindicate the procedure.
Dense cataract: Significant lens opacity must be corrected before keratopigmentation to evaluate the final result and maximize visual quality.
History of corneal graft rejection: Dysregulated corneal immunology increases the risk of excessive inflammatory reaction.
Corneal neuropathy: Certain diabetic patients or those with a history of significant refractive surgery present corneal hypoesthesia, slowing the healing process.

Psychological and Behavioral Criteria

The contraindications to FLAAK keratopigmentation are not solely medical. Beyond purely ophthalmological criteria, Yoni Gozlan, M.D. also evaluates psychological and behavioral candidacy:

Unrealistic expectations: A patient expecting a radical modification of iris color, without understanding that the pigment is deposited in the cornea, cannot be treated. Transparency regarding expected results is essential.
Inability to follow postoperative instructions: The postoperative period requires strict hygiene, the use of eye drops, and adherence to follow-up visits. A lack of compliance contraindicates the procedure.
Psychological instability or obsessive disorder: Certain patients with significant appearance-related anxiety may not benefit from an eye color change if it does not correspond to a stable and considered expectation.

These psychological contraindications to FLAAK keratopigmentation are evaluated during consultation by Dr. Gozlan.

Preliminary Evaluation: Essential Examinations

To rule out any contraindication to FLAAK keratopigmentation before the procedure, Dr. Gozlan systematically performs:

Corneal topography and tomography: To determine the shape, thickness, and exclude keratoconus or ectasia.
Ultrasonic or optical pachymetry: Precise measurement of corneal thickness, a decisive element.
Schirmer test and tear film evaluation: To quantify dry eye.
Slit-lamp examination: To detect scars, opacities, or signs of herpetic infection.
Gonioscopy: Evaluation of the iridocorneal angle and glaucoma status.
Ocular refraction: Evaluation of optical correction and refractive surgery history.

FAQ: Contraindications to FLAAK Keratopigmentation

I have keratoconus: can I undergo FLAAK keratopigmentation?

No, keratoconus is an absolute contraindication to FLAAK keratopigmentation. This progressive corneal deformation compromises the creation of a regular corneal tunnel and drastically increases the risk of postoperative complications, particularly induced ectasia. Yoni Gozlan, M.D. will only offer this technique if your cornea is stable and shows no signs of keratoconus or ectasia.

I had LASIK 10 years ago: am I a candidate for keratopigmentation?

Possibly, but it depends on your residual pachymetry (remaining corneal thickness after LASIK). This is one of the most common contraindications to FLAAK keratopigmentation after LASIK: if your cornea measures less than 450 µm, the procedure is contraindicated. A detailed corneal topography and pachymetry will be performed by Yoni Gozlan, M.D. to assess your exact eligibility.

What about corneal scars from a previous trauma?

Old corneal scars represent contraindications to FLAAK keratopigmentation depending on their location and density. If the scar is in the central optical zone or significantly alters the stromal architecture, keratopigmentation cannot be offered. A consultation with Yoni Gozlan, M.D. will determine whether your situation presents a definitive contraindication or whether prior treatment (graft or cross-linking) is an option.

Does dry eye contraindicate FLAAK keratopigmentation?

Mild to moderate dry eye is not an absolute contraindication to FLAAK keratopigmentation, but it requires pretreatment to optimize postoperative outcomes. Severe dry eye is a relative contraindication that may be resolved after intensive treatment (punctal plugs, hyaluronate, anti-inflammatory agents). Dr. Gozlan evaluates this condition during the initial consultation.

What role does corneal thickness play in contraindications?

Corneal thickness (pachymetry) is a key criterion among the contraindications to FLAAK keratopigmentation. A cornea thinner than 450 µm is generally contraindicated because it does not have sufficient stromal reserve to accommodate the FLAAK tunnel without the risk of ectasia or biomechanical weakness. This measurement is systematically performed during your preliminary assessment.

Does a history of corneal herpes permanently contraindicate keratopigmentation?

An old, healed history of corneal herpes may not constitute a permanent contraindication to FLAAK keratopigmentation, but the situation must be evaluated on a case-by-case basis. Recent herpes, active keratitis, or significant herpetic corneal scarring do represent a contraindication. Antiviral prophylaxis may be offered before the procedure if necessary. Dr. Gozlan will guide this decision.

When Should You Consult Yoni Gozlan, M.D.?

Are you considering FLAAK keratopigmentation and want to know if you have a contraindication? Do you have an ophthalmic history (LASIK, suspected keratoconus, corneal scar, dry eye) and wish to know whether you present contraindications to FLAAK keratopigmentation? Yoni Gozlan, M.D. provides a comprehensive consultation to evaluate your profile, confirm the absence of contraindications to FLAAK keratopigmentation, and offer the eye color change solution best suited to your situation.

📍 Consultation at Clinique Laser Victor Hugo – Paris 16

Yoni Gozlan, M.D. welcomes you at Clinique Laser Victor Hugo, 27 bis avenue Victor Hugo 75116 Paris to discuss your eye color change project through FLAAK keratopigmentation, evaluate your candidacy with regard to the contraindications to FLAAK keratopigmentation, and present the possible results with full transparency.

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