What is scleral icterus?
Scleral icterus is the yellowing of the white part of the eye, known as the sclera, and is a visible sign of jaundice. Yellow pigments, mainly bilirubin, build up in the tissue of the eyes. This yellowing is usually noticed earlier than yellowing of the skin and is an important symptom that can point to a problem with the body's metabolism or a liver condition.
How does the yellowing of the eyes happen?
Bilirubin is a waste product made when the red pigment in blood, called haemoglobin, breaks down. Normally, the liver processes bilirubin and it is then passed out of the body through bile. If something goes wrong in this process, for example because the liver is overworked, the bile ducts are blocked, or too many red blood cells are breaking down, the level of bilirubin in the blood rises. Because the sclera is very sensitive to changes in bilirubin, the yellowing appears there especially early and clearly.
The eyes then no longer look clear white but take on a yellowish, and sometimes even orange, tone. This is often the first sign that something is not right in the body.
Causes of scleral icterus
There are several different reasons why scleral icterus can occur. A liver condition is often behind it, such as acute or chronic hepatitis, a fatty liver, or liver cirrhosis. A blockage of the bile ducts, for example caused by gallstones or tumours, can also mean that bilirubin is no longer properly removed from the body.
Sometimes the cause is outside the liver. One example is a condition called haemolytic anaemia, where many red blood cells break down at once, producing a very large amount of bilirubin. Certain medicines or rare inherited metabolic disorders can also cause scleral icterus.
Is scleral icterus dangerous?
Scleral icterus is always a warning sign that should be taken seriously. The yellowing itself is not harmful, but it shows that there is a problem in the body that needs to be investigated. Other symptoms often appear alongside it, such as tiredness, dark urine, pale stools, itching, or pain in the upper right side of the abdomen.
Whether scleral icterus is serious depends on the underlying cause. Some causes are harmless and easy to treat, while others require prompt medical investigation and treatment. Scleral icterus that appears suddenly should always be examined by a doctor to rule out serious conditions.
What happens during an examination?
To find the cause of scleral icterus, a doctor will first ask detailed questions and carry out a physical examination. Blood tests give information about how high the bilirubin level is and whether the liver is working properly. Liver enzymes, a full blood count, and other values are often checked.
Imaging methods such as ultrasound help to show changes in the liver or bile ducts. Depending on the findings, further investigations may be needed, such as specialist blood tests, a CT scan, or, in rare cases, a tissue sample.
Treatment options for scleral icterus
Treatment always depends on the cause. If there is inflammation of the liver, treating that condition is the main focus. If a gallstone is blocking the bile, a small procedure may be needed to remove the blockage. If haemolytic anaemia is the cause, the underlying changes in the blood are treated.
Sometimes it is enough to stop a medicine that is causing the problem or to change the diet. In other cases, a targeted course of treatment is needed, which may sometimes require a stay in hospital. It is important that treatment is always tailored to the individual and that an accurate diagnosis comes first.
What should be looked out for?
Scleral icterus is a clearly visible sign that should not be ignored. Even if there are no other symptoms, it is sensible to seek medical advice. This becomes especially important if additional symptoms appear, such as severe tiredness, pain, fever, or a noticeable change in the colour of urine or stools.
Even if the yellowing disappears after a short time, the cause should still be investigated. This means that serious conditions can be identified and treated early.
