OBJECTIVES: This study compares the cosmetic and functional outcomes of corneal tattooing/keratopigmentation and ocular prostheses in rehabilitating disfigured eyes, focusing on esthetic appearance and emotional well-being. METHODS: Ninety-two patients were included: 48 received corneal tattooing, and 44 were fitted with ocular prostheses. Anophthalmic surgery was indicated for trauma, painful blind eye, endophthalmitis, tumor, and corneal ulcer, while corneal tattooing was performed for trauma, corneal ulcer, and endophthalmitis. Comprehensive ophthalmic examinations, a seven-item satisfaction questionnaire, and assessments of ocular movement in four directions and postoperative complications (e.g., infection, enophthalmos, fornix loss, and eyelid disorders) were conducted. RESULTS: Patients who underwent ocular cosmetic rehabilitation reported high satisfaction, with corneal tattooing yielding higher satisfaction rates across all measures ( P <
0.001). Patients with corneal tattooing exhibited significantly better ocular movement in all four cardinal directions ( P <
0.001 for temporal, nasal, superior, and inferior). The prosthesis group experienced more postoperative complications, including ocular surface disorders and structural anomalies. CONCLUSION: Corneal tattooing and ocular prostheses both provide viable options for rehabilitating disfigured eyes. Corneal tattooing offers advantages in ocular movement, fewer complications, and higher patient satisfaction, while ocular prostheses are more suitable for addressing phthisis bulbi, tumors, and ocular pain.