What Yellow Sclera Says About Your Health

By Dr. Larry Heit

Have you noticed that the normally white part of your eye has developed a yellow tint or yellow spots? When the whites of your eyes turn yellow, it may indicate a serious problem, such as liver trouble. However, sclera discoloration can also be caused by a pinguecula, a benign eye condition resulting from excessive UV exposure. Let’s explore what causes the whites of your eyes to turn yellow and what steps you can take to preserve your health.

What Is the Sclera, and Why Does It Turn Yellow?

The sclera is the white part of the eye and normally appears bright white, but certain eye conditions and health problems can cause it to change color. For example, the white part of the eye may turn pink or red, sometimes with visible red lines, which can indicate irritation or infection, like pink eye. Brown spots may appear as harmless eye freckles. You might also notice that all or part of the sclera has turned yellow. Partial sclera yellowing, especially near the nose, may be caused by a pinguecula, which is a yellowish bump that typically forms due to excessive exposure to Ultraviolet light. If it continues to grow, it can lead to surfer’s eye. By contrast, when the entire sclera takes on a yellow hue, a condition often called jaundice, it may signal liver, pancreas or gallbladder trouble. Remember, a yellow sclera is a symptom, not a diagnosis.

What Is Scleral Icterus, and Why Does Bilirubin Matter?

Scleral icterus, sometimes called conjunctival icterus, is characterized by yellowing of the white part of the eye. One common reason for this sclera discoloration is a buildup of bilirubin, a waste product produced when the body breaks down old red blood cells. Once bilirubin is produced, it is transported to the liver, where it is processed into bile. The bile is then released into the intestines and eventually eliminated in the stool. The creation and excretion of bilirubin are natural processes. However, bilirubin can be toxic if it accumulates in the body. When the liver, gallbladder, or other systems are unable to process it properly, the buildup can cause yellowing of the eyes and skin. This condition is called hyperbilirubinemia, or more commonly, jaundice. Depending on the underlying cause, individuals may experience symptoms such as abdominal swelling, pain, chills, fever, fatigue, nausea and lightheadedness. They may also notice dark urine and light-colored stools.

Why Do the Eyes Turn Yellow Before the Skin?

The eyes often turn yellow before the skin because the sclera is more sensitive to the buildup of bilirubin. If you’ve noticed that the whites of your eyes have turned yellow, it’s important to see a medical professional right away.

What Conditions Cause the Sclera to Turn Yellow?

Several conditions and even some medications can cause the sclera to turn yellow. Let’s take a look at these medical issues.

Pinguecula – Pinguecula is an eye condition that’s caused by excessive UV exposure combined with wind and dust. This condition causes a small part of the sclera near the nose to turn yellow. If it continues to grow, it can develop into surfer’s eye.
Taking Certain Medications – Some medications have been known to cause the eyes and skin to turn yellow. Those medications include penicillin, birth control pills, chlorpromazine, steroids and acetaminophen, if too much is consumed.
Hepatitis – Hepatitis is characterized by an inflammation of the liver. It’s most often caused by a virus, and when the liver becomes inflamed, it cannot efficiently process bilirubin, which can lead to jaundice.
Cirrhosis – Cirrhosis occurs when healthy liver tissue is gradually replaced by scar tissue, which interferes with liver function. Alcohol abuse is one of the most common causes of liver damage that leads to jaundice. Other causes include obesity and chronic infections such as hepatitis B or C.
Gallstones – Gallstones can grow large enough to block bile ducts. When this occurs, bilirubin cannot flow from the liver into the intestines, and instead, backs up into the bloodstream.
Blood Transfusion Error – In rare cases, an individual might receive the wrong type of blood during a transfusion. This can cause the individual’s immune system to destroy the transfused blood, leading to a yellowing of the skin and eyes.
Anemia – Sickle cell anemia can lead to jaundice because the normally round blood cells are curved and exceptionally sticky. Because of this, they tend to die faster than the liver can process them. This can lead to a buildup of bilirubin, which causes the skin and eyes to turn yellow.
Malaria – Malaria is a parasitic infection that causes the blood cells to become damaged or die prematurely. This can lead to both anemia and jaundice.
Pancreas Problems – If the pancreas is infected or has a tumor, it may lead to jaundice.

Can Dehydration, Lack of Sleep, or Eye Drops Cause Yellowing?

Dehydration, lack of sleep and regular use of eye drops generally do not cause yellowing of the eyes. Dehydration may make the eyes appear red or irritated, while lack of sleep can lead to tired, bloodshot eyes. Certain medications, however, can affect liver function, which in rare cases may contribute to sclera yellowing. Medications that have been known to harm the liver include acetaminophen, amoxicillin, diclofenac, amiodarone, allopurinol, phenytoin, methotrexate and some cancer medications. If you are concerned that a medication may be causing your yellow eyes, it’s best to talk to your family doctor.

When Yellow Sclera Is Urgent

A yellowing of the sclera should be taken seriously, especially if it occurs alongside dark urine, pale stools or abdominal pain. These symptoms may indicate a potentially serious issue involving the liver, gallbladder or pancreas, and getting prompt medical evaluation is recommended.

When Should I See a Doctor or Go to Urgent Care for Yellowing of the Eyes?

Since having yellow eyes can be a sign of excess bilirubin in the blood, it’s typically recommended to consult your family physician or internist for an evaluation. If the yellowing is accompanied by pale stools, abdominal pain, dark urine, fever or itchy skin, you should seek immediate medical care in the closest emergency room.

When Does Yellow Eyes Not Mean Jaundice?

If you notice a small yellow spot on your eye, rather than the entire sclera turning yellow, it may be a pinguecula rather than jaundice. A pinguecula is a yellowish bump on the eye, usually located on the side nearest the nose. This condition occurs when the tissues of the conjunctiva thicken. Risk factors include chronic UV exposure, wind and dust, as well as older age and contact lens use. Treatment often involves monitoring the spot, wearing sunglasses and keeping the eyes lubricated with eye drops. If the pinguecula continues to grow, it can turn into pterygium or surfer’s eye. If this condition becomes uncomfortable or affects your vision, your Atlanta ophthalmologist may recommend surgical removal. Age can also play a role. As people get older, the sclera often loses some of its bright white appearance and can take on a slightly duller or off-white tint. This is a normal part of aging and no cause for concern on its own.

Can Diet Turn Skin Yellow Without Turning the Whites of the Eyes Yellow?

Diets high in beta-carotene can sometimes cause the skin to turn yellow or orange, particularly on the palms of the hands and heels of the feet. This condition is called carotenemia. Foods high in beta-carotene include carrots, spinach, sweet potatoes, kale, tomatoes, cantaloupe, and papayas. Carotenemia is usually harmless, and a diagnosis can often be made through a physical examination and dietary history with your family physician. Most people’s skin returns to normal after reducing intake of beta-carotene-rich foods.

What an Eye Exam Can and Cannot Do When Your Eyes Are Yellow

If you notice eye discoloration, an eye exam with one of our eye care providers can help determine whether the cause is ocular or if further medical evaluation is needed. During the exam, our eye doctor can assess your visual acuity, check the overall health of your eyes, and look for eye conditions such as pinguecula.

If a pinguecula is causing the yellowing, the eye doctor can recommend appropriate treatment, such as monitoring, eye drops or lifestyle adjustments. However, if the yellowing is due to excess bilirubin or another systemic condition, your eye care provider may refer you to your primary care physician or a specialist for additional testing, such as blood work or imaging.

What Will Thomas Eye Group Look for During an Exam if I’m Worried About Yellow Sclera?

If you’re concerned about the yellowing of the whites of your eyes, our ophthalmologist can examine your eyes to determine the cause of scleral icterus. During the exam, they will also ask about your symptoms, such as fatigue, abdominal pain, or an upset stomach. Your medication history will be reviewed, including both prescription and over-the-counter drugs. Certain medications, such as acetaminophen, steroids, and penicillin, can affect liver function, leading to jaundiced eyes.

Our ophthalmologist may also discuss your lifestyle and habits. They might ask about alcohol consumption, your regular diet and whether you have a family history of liver, gallbladder, or pancreas problems.

Finally, they may ask about your recreational activities and environmental exposures. For example, do you spend significant time in windy or dusty conditions, surf, or spend long periods outdoors without sunglasses? These factors can contribute to conditions like pinguecula or pterygium.

If It Looks Like Scleral Icterus, What Referrals or Next-Step Tests Are Typical?

If our ophthalmologist determines that you have scleral icterus, they will likely recommend follow-up testing with your primary care physician. These tests may include blood work, a bilirubin measurement, urinalysis and a hepatitis panel. In some cases, you may also be referred for imaging studies or to a gastroenterologist for further evaluation.

Should I Schedule an Eye Exam with Thomas Eye Group Even if I Feel Fine?

If you’ve noticed a yellow tint in your eyes, it’s important to have it checked at one of our Atlanta area locations. We have clinics in Atlanta, Sandy Springs, Cumming, Buford, Lilburn, Marietta and the surrounding areas that can help diagnose the cause of your yellowing of the eyes, and the truth is that your eye yellowing could be caused by something simple, like eating too many beta-carotene-rich foods or spending too much time outside, especially if you participate in water sports. Of course, your icteric sclera could also be caused by a problem with your liver, gallbladder or pancreas. To be sure, it’s best to get your eyes examined and follow-through with any referrals or follow-up appointments.

To schedule an appointment with one of our eye care providers in Atlanta for your jaundiced eyes, all you have to do is visit us online or call us at 678-892-2020. You can even text us directly on our contact us page to get questions answered or for help scheduling an appointment.

About Larry Heit, M.D.

Larry E. Heit, M.D. is a board-certified ophthalmologist and fellowship-trained cataract surgeon serving at Thomas Eye Group’s Roswell, GA location, with nearly 20,000 cataract surgeries performed. He earned his medical degree from the State University of New York in Brooklyn and completed his fellowship at the Cullen Eye Institute at Baylor College of Medicine.