What is Scleral Icterus?

Scleral icterus is a yellowing of the whites of the eyes that most classically occurs in patients with liver disease. People with this problem may experience a change in color that ranges from a muddying to a bright yellow or orange discoloration. This phenomenon is a symptom, rather than an underlying condition, and it is resolved when the cause of the liver problems is treated.

In people with scleral icterus, the body's processing system for bilirubin, a pigment normally handled by the liver, breaks down. Bilirubin is a byproduct of the breakdown of red blood cells, and it travels through the bloodstream to the liver, where it is converted into a form that can be expressed by the body. In some people, a problem can occur along the way to the liver, in the liver, or in the process of expressing the bilirubin from the body. The pigment circulates in the blood, and becomes deposited in the conjunctiva, the membrane that covers the whites of the eye. It can also be present in the skin, causing it to turn yellow along with the eyes.

This yellowing is also known as jaundice, which can develop because of liver inflammation or infection, liver cancer, alcoholism, bile duct obstructions, and certain medications. Sometimes, it is seen in newborn infants as well. When a patient has jaundice, the first step in treatment is to determine why. A series of tests can be used to check levels of liver enzymes, bilirubin in the blood, and other key signs. Discoloration of the eyes will be classified as pre-hepatic, hepatic, or post-hepatic, depending on where the problem with processing the bilirubin lies.

Sometimes, people have naturally dark sclera, and it can be difficult to identify scleral icterus. Self reporting from a patient is very useful in these cases, as patients as well as friends and family can tell care providers whether or not apparent discoloration is abnormal. Generally, people with darker skin are more likely to have cream colored, rather than white, scleras, although this is not always the case. The vision is not distorted by the discoloration, belying the slang term “with a jaundiced eye” to refer to viewing something with prejudice.

Some conditions that cause jaundice can be resolved with medical treatment, while others can only be controlled. People in liver failure, for example, usually need new livers, and may need to stay in the hospital to receive skilled nursing care while they await organs suitable for transplant. In newborns with jaundice, phototherapy sessions can be used to treat the patient and the eyes and skin will gradually return to a more conventional shade.