Scleral jaundice is a yellowing of the whites of the eyes due to a breakdown in the body’s processing system for bilirubin, a pigment normally handled by the liver. It can be a symptom of liver disease, inflammation, infection, cancer, alcoholism, bile duct blockages, or some medications. Treatment involves identifying the underlying cause and can range from medical treatment to organ transplant.
Scleral jaundice 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 color change ranging from a muddy discoloration to a bright yellow or orange discoloration. This phenomenon is a symptom, rather than an underlying condition, and resolves when the cause of the liver problems is treated.
In people with scleral jaundice, 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 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 may occur along the way to the liver, either in the liver or in the process of extracting bilirubin from the body. The pigment circulates in the blood and is deposited in the conjunctiva, the membrane that covers the white 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 due to liver inflammation or infection, liver cancer, alcoholism, bile duct blockages, and some medications. Sometimes, it is seen in newborns 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, blood bilirubin, and other key signs. Eye discoloration will be classified as pre-hepatic, hepatic, or post-hepatic, depending on where the problem with bilirubin processing lies.
Sometimes, people have naturally dark sclerae, and it can be difficult to identify scleral jaundice. A patient’s self-report is very helpful in these cases, as patients, friends and family can tell healthcare professionals whether or not the apparent discoloration is abnormal. Generally, people with darker skin are more likely to have cream colored, rather than white sclerae, although this is not always the case. Vision is not distorted by discoloration, belying the slang term “jaunded eye” to refer to seeing something with prejudice.
Some conditions that cause jaundice can be resolved with medical treatment, while others can only be controlled. People with liver failure, for example, usually need new livers and may need to stay in the hospital to receive skilled nursing care while they wait for suitable organs for transplant. In newborns with jaundice, light therapy sessions can be used to treat the patient and the eyes and skin will gradually return to a more conventional shade.
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