It is common for people to have some yellowish discoloration in the whites of their eyes. This is known medically as scleral icterus. In most cases, a small amount of yellow in the eyes is normal and no cause for concern. However, significant yellowing of the sclera can be a sign of an underlying medical condition that may require treatment. This article explores the common causes of yellow eyes, when it may indicate a health problem, and what to do if you notice yellowing of the sclera.
What Causes Yellowing of the Eyes?
The white outer layer of the eye is known as the sclera. This tissue contains many blood vessels that provide oxygen and nutrients to the eye. The sclera normally appears white due to the reflection of light off the surface of the eye. However, when certain pigments build up in the bloodstream or tissue of the eye, they can cause the sclera to take on a yellowish tint. This is called scleral icterus.
The most common cause of yellow eyes is the accumulation of bilirubin in the blood. Bilirubin is a yellowish pigment produced when old red blood cells break down. Healthy levels of bilirubin are around 0.3 to 1.9 mg/dL. When bilirubin levels rise above 2 mg/dL, it can start to accumulate in the sclera causing yellowish discoloration.
Some common causes of increased bilirubin production include:
- Liver disease – Impaired liver function can prevent the proper excretion of bilirubin into bile leading to buildup in the blood.
- Gilbert’s syndrome – A genetic disorder that impairs bilirubin metabolism.
- Hemolytic anemia – Conditions where red blood cells are destroyed prematurely.
- Infections – Such as mononucleosis and hepatitis.
- Blocked bile ducts – From gallstones or tumors.
In addition to increased bilirubin, other pigments can also cause the sclera to appear yellow:
- Carotene – Found in carrots and some other vegetables, carotene can build up in the body and cause yellow discoloration of the skin and eyes.
- Riboflavin – High dose vitamin B2 supplements can temporarily turn the urine and sclera yellow.
- Jaundice of the newborn – Caused by immature liver function and metabolism in newborns.
- Pinguecula – Yellowish fatty deposits on the conjunctiva of the eye.
For many people, a small amount of yellow in the sclera is just a normal variation in eye coloration. However, pronounced or progressively worsening yellowing can indicate an underlying disorder.
When is Yellowing of the Eyes a Health Concern?
Mild scleral icterus where the eyes have a slight yellowish tinge is usually harmless in adults. However, more pronounced yellowing or yellowing that has recently developed can be a sign of serious illness.
You should see a doctor promptly if you experience:
- Sudden onset of yellow eyes
- Worsening yellow coloration over days or weeks
- Yellowing accompanied by other symptoms like fatigue, itching, abdominal pain
- Deep yellow or orange color of the sclera
- Yellowing of the skin in addition to the eyes (jaundice)
- Yellow eyes in infants under 6 months old
Some of the conditions that can cause concerning levels of yellowing include:
- Liver disease – Such as viral hepatitis, cirrhosis, or liver cancer.
- Gallbladder disease – Gallstones or cholecystitis.
- Hemolytic anemia – From inherited conditions like sickle cell or autoimmune disorders.
- Pancreatic cancer – Which can obstruct bile flow.
- Malaria – A parasitic infection that can rupture red blood cells.
Prompt evaluation and treatment is important for these types of conditions to prevent serious complications. In infants, severe jaundice requires immediate medical assessment to check bilirubin levels and prevent brain damage from toxicity.
When to See a Doctor
You should make an appointment with your doctor if:
- Your eyes appear more yellow than normal
- The yellow tint in your eyes seems to be getting worse
- Yellowing happens suddenly over a day or two
- Your eyes are yellow and you have other symptoms like itching, nausea, fatigue, or fever
- The whites of your infant’s eyes appear yellow before 6 months old
Depending on your symptoms, your doctor may recommend:
- Blood tests to check bilirubin, liver enzymes, and kidney function
- Ultrasound of the liver and bile ducts
- Evaluation for viral hepatitis, mononucleosis, or autoimmune disorders
- Testing your infant’s bilirubin levels
- Medications or phototherapy to lower high bilirubin
- ER evaluation for severe jaundice
Identifying any underlying disease and starting appropriate treatment can help prevent complications. Some causes of yellow eyes like Gilbert’s syndrome may require little intervention apart from periodic monitoring.
When Yellowing is Normal
Many adults have a minor yellowish tinge to the sclera that is considered normal. Some factors that relate to yellowing not linked with disease include:
- Age – Scleral coloring can become more yellow with aging.
- Genetics – Some eye pigmentation is inherited.
- Ethnicity – Those with darker skin often have some yellow tones in the sclera.
- Smoking – Chronic smoking can stain the sclera yellow.
- Alcohol use – Can cause mild yellow discoloration of the eyes.
- Medications – Such as tetracyclines, amiodarone, chlorpromazine.
As long as the degree of yellowing does not appear to be worsening and you have no other symptoms, these causes are not concerning. Also, in nearly all infants, a small amount of physiological jaundice causing mild yellowish discoloration of the sclera is normal in the first week of life as their bilirubin metabolism and liver function matures. But severe or worsening jaundice in newborns requires prompt evaluation.
Treatments for Yellowing Eyes
The appropriate treatment for yellow eyes depends on the underlying cause. Some options may include:
- Treating infections – Antibiotics for infectious hepatitis.
- Managing autoimmune disorders – Immunosuppressants for autoimmune hemolytic anemia.
- Surgery – To remove gallstones obstructing bile flow or to treat cancers of the liver, pancreas, or bile ducts.
- Medications – Ursodeoxycholic acid to improve bile flow in certain liver diseases.
- Phototherapy – Using blue light to help break down bilirubin in jaundiced newborns.
- Blood transfusions – For severely anemic patients to decrease bilirubin production.
The outlook depends on the specific cause. In benign cases like Gilbert’s syndrome, the yellowing requires little treatment apart from routine monitoring. With prompt and appropriate management of serious underlying diseases, many patients can recover well and see an improvement in jaundice and yellowed sclera.
Preventing Yellow Eyes
It’s not always possible to prevent yellow discoloration of the sclera, especially when its related to genetic, ethnic, or aging factors. But the following healthy habits may help reduce your risk:
- Avoid excessive alcohol intake which can irritate the liver.
- Don’t smoke and avoid secondhand smoke.
- Eat a balanced diet low in saturated fat.
- Drink plenty of fluids to stay well hydrated.
- Protect yourself against infectious diseases like viral hepatitis.
- Have regular physical exams to screen for conditions like diabetes and liver disease.
- See your doctor promptly if you develop signs of jaundice.
While some yellowing of the sclera can be normal, significant changes in color of the whites of the eyes or accompanying symptoms should be evaluated promptly. With an accurate diagnosis, yellow eyes often respond well to medical treatment of the underlying condition.
Conclusion
A slight yellowish discoloration of the sclera is common and usually harmless, especially in older adults. But pronounced, progressive, or sudden yellowing of the eyes can signal an underlying liver disorder, infection, anemia, or other illness requiring medical assessment. See your doctor promptly if you notice worsening yellowing of your eyes or yellowing combined with other symptoms. With proper treatment guided by an accurate diagnosis, many causes of yellow eyes carry a favorable outlook. Maintaining healthy lifestyle habits can also help minimize your risk of developing conditions associated with yellow eyes.
