Yellowing of the eyes, known medically as jaundice, can be caused by a number of underlying conditions. While some causes may be harmless, others can signal serious health issues that require prompt medical attention. Understanding the potential reasons for yellow eyes, when to seek help, and how jaundice is evaluated and treated is key to getting the best outcome if you notice this symptom.
What Causes Yellow Eyes?
There are several possible causes of yellowing eyes:
Liver Conditions
One of the most common reasons for jaundice is a problem with the liver. The liver produces a yellow-orange substance called bilirubin, which is formed from the breakdown of old red blood cells. Normally, the liver secreted bilirubin into bile, which passes into the intestines and leaves the body in stool. But when the liver is damaged or disease, bilirubin can build up and leak into the bloodstream. As bilirubin circulates through the body, it causes yellow discoloration of the skin and eyes.
Examples of liver conditions that can cause jaundice include:
– Hepatitis: Inflammation of the liver, often caused by viral infections like hepatitis A, B, and C. Alcohol abuse and autoimmune disorders can also trigger hepatitis.
– Cirrhosis: Permanent scarring that replaces healthy liver tissue. Caused by chronic liver diseases like hepatitis, alcoholism, and fatty liver disease.
– Cancer: Liver cancer or cancer that has spread to the liver from elsewhere.
– Gallstones: Hard deposits that form in the gallbladder and block the flow of bile.
Red Blood Cell Problems
Issues with red blood cells can also lead to a buildup of bilirubin and jaundice:
– Hemolytic anemia: Conditions where red blood cells are broken down prematurely. Causes include sickle cell anemia, infections, autoimmune disorders, hereditary spherocytosis, and exposure to certain chemicals or medicines.
– Red blood cell defects: Abnormal red cell shapes or enzyme deficiencies that reduce red blood cell lifespan. Examples are thalassemias and G6PD deficiency.
Bile Duct Obstruction
When the bile ducts are blocked, bile cannot drain properly from the liver. Bilirubin then leaks backward into the bloodstream. Causes include:
– Gallstones
– Tumors of the pancreas, bile ducts, or liver
– Scarring of bile ducts from surgery, injury, or chronic pancreatitis
– Parasitic infections like liver flukes
Other Causes
Less common causes of yellowing eyes include:
– Newborn jaundice: Normal breakdown of fetal red blood cells after birth causes unconjugated hyperbilirubinemia in 60% of newborns in the first week of life. Most cases are mild and resolve without treatment.
– Infections: Such as malaria and mononucleosis.
– Medications and supplements: Including acetaminophen, non-steroidal anti-inflammatories, antibiotics, statins, steroids, multivitamins with iron, and niacin.
– Autoimmune disorders: Like primary biliary cholangitis.
– Metabolic disorders: Such as Gilbert syndrome, a mild condition causing unconjugated hyperbilirubinemia.
– Crigler-Najjar syndrome: A rare hereditary disorder impairing bilirubin processing.
When to See a Doctor
Contact your doctor promptly if you notice any yellowing in the whites of your eyes. Jaundice is never normal and should be evaluated, especially when accompanying symptoms are present. Seek emergency care for:
– Yellow eyes in infants under 2 weeks old
– Severe abdominal pain
– Fever over 101 F
– Confusion or altered mental status
– Vomiting blood or passing bloody stool
– Skin that looks very yellow or even green-tinged
Call your doctor if yellowing eyes occur alongside:
– Fatigue, nausea, loss of appetite
– Stomach pain, itching, dark urine
– Light-colored stools, diarrhea
– Recent infections, new medications, supplements
– Exposure to contaminated food/water when traveling
Prompt evaluation for jaundice is important because some causes can rapidly worsen if left untreated. And remember, the severity of jaundice does not always correlate with how serious the underlying problem is. Even mild yellowing requires an examination.
Medical Evaluation of Jaundice
If you see an unexplained yellow tint in your eyes, your doctor will take a full history and perform a physical exam. Diagnostic testing helps determine the specific cause:
Blood Tests
Blood tests measure levels of bilirubin and liver enzymes:
– Total and direct/indirect bilirubin levels indicate whether jaundice is due to pre-hepatic, hepatic, or post-hepatic causes.
– Elevated liver enzymes signify liver injury. Specific patterns of abnormal enzymes point to different diseases.
Other blood tests check for anemia, indicators of viral hepatitis, autoantibodies related to autoimmune disorders, and more based on clinical presentation.
Imaging Tests
Scans like ultrasound, CT, MRI, MRCP, and HIDA scans visualize the liver, bile ducts, gallbladder, pancreas, and other abdominal organs. They detect structural abnormalities like stones, strictures, tumors, and obstruction that can underly jaundice.
Liver Biopsy
Removing a small sample of liver tissue for microscopic examination can help confirm diagnoses like cirrhosis, hepatitis, cancer, iron/copper accumulation, and fatty liver disease.
Cholangiography
Injecting contrast dye into the bile ducts followed by x-rays or CT imaging lets doctors see bile flow for blockages. Done at ERCP or PTC procedures.
Stool Test
Looking at stool color and testing for bilirubin directly can assist in finding the cause of jaundice.
| Test | Purpose |
|---|---|
| Blood tests | Measure bilirubin levels, liver enzymes, viral hepatitis markers, anemia, autoantibodies |
| Imaging tests | Ultrasound, CT, MRI to visualize liver, bile ducts, gallbladder, pancreas |
| Liver biopsy | Examines liver tissue sample microscopically to diagnose diseases |
| Cholangiography | Contrast x-ray or CT scan showing bile ducts during ERCP or PTC |
| Stool test | Checks stool color and tests for presence of bilirubin |
Treatment for Jaundice
Treatment focuses on the specific underlying condition causing yellowing of the eyes.
Treating Liver Diseases
– Hepatitis is managed by addressing the source of infection and limiting further liver damage. Antiviral medications may be prescribed for chronic viral hepatitis.
– Alcoholic and non-alcoholic fatty liver disease is treated by abstaining from alcohol use and implementing lifestyle changes like diet, exercise, and weight loss.
– Cirrhosis treatment centers on limiting progression. Guidelines include healthy eating, abstaining from alcohol, medication, supplements, vaccinations, and screening for complications.
– Liver cancer treatment options are tumor removal, liver transplant, ablation, embolization, radiation, chemotherapy, and targeted drug therapy.
Fixing Bile Flow Problems
– Gallstones may be managed by a cholecystectomy surgery or ursodeoxycholic acid to dissolve stones. ERCP can remove common bile duct stones.
– Blocked bile ducts can be opened via ERCP, stent placement, or surgery.
– Liver flukes are treated with anti-parasitic medications like praziquantel.
Managing Anemia
Depending on the cause, anemia may be treated with iron supplementation, blood transfusion, corticosteroids, splenectomy, bone marrow transplant, or medication for deficiencies like vitamin B12, folic acid, and G6PD.
Stopping Causative Medications
Switching implicated prescription medications, over-the-counter drugs, supplements, and herbal remedies under medical supervision.
Phototherapy for Newborn Jaundice
Placing newborns under specialized blue lights helps break down excess bilirubin and prevent complications of hyperbilirubinemia.
Waiting It Out
In mild, transient, or benign cases of jaundice, the yellow tint resolves on its own as the underlying issue improves. Your doctor will advise if waiting and observing symptoms is appropriate.
Complications of Untreated Jaundice
If the underlying cause of jaundice is not diagnosed and treated, serious complications can develop:
– Bilirubin encephalopathy: Bilirubin passing into the brain causes neurological damage, especially in newborns. Can lead to cerebral palsy, intellectual disability, developmental delays, seizures, auditory problems, and tooth enamel defects.
– Liver failure: Untreated liver diseases like hepatitis, cirrhosis, and cancer can eventually cause life-threatening liver failure.
– Sepsis: Liver dysfunction impairs the body’s ability to fight infections, increasing the risk of an overwhelming systemic infection.
– Vitamin deficiencies: Poor nutrient absorption from liver and bile duct damage can lead to deficiencies in fat-soluble vitamins A, D, E, K.
– Gallbladder inflammation, rupture: Advanced gallstone disease untreated can result in cholecystitis, empyema, gangrene, and gallbladder perforation.
– Hepatocellular carcinoma: Cirrhosis from chronic liver disease is linked to an increased risk of primary liver cancer.
– Death: Progressive liver failure, sepsis, bleeding, fluid retention, and metabolic derangements make jaundice potentially fatal without proper treatment.
Preventing Jaundice
You can reduce your risk of developing jaundice by:
– Getting vaccinated against hepatitis A and B
– Avoiding IV drug use, sharing needles
– Practicing safe sex, using condoms
– Only drinking alcohol moderately, if at all
– Maintaining normal weight and managing conditions like obesity, diabetes, and dyslipidemia
– Taking medications and supplements only as prescribed
– Not ignoring symptoms like abdominal pain, fever, nausea
– Seeing your doctor for regular checkups to monitor liver health
Outlook for Yellow Eyes
The prognosis for jaundice varies substantially based on the underlying cause. Mild transient jaundice often resolves without issue once managed. But chronic cases related to deteriorating liver function can become serious and life-threatening if not treated. In general:
– Hepatitis: Antiviral medications can effectively treat and even clear some forms of viral hepatitis before cirrhosis develops. Stopping alcohol use also improves hepatitis outcomes.
– Hemolytic anemia: Treating the cause can resolve jaundice, but lifelong monitoring of anemia is usually required.
– Liver cancer: Early stage tumors surgically removed can lead to long term survival, but jaundice from advanced liver cancer has a poor prognosis.
– Medication side effects: Jaundice normally resolves within 1-4 weeks of stopping the causative drug.
– Benign hereditary jaundice syndromes usually need no treatment and do not affect lifespan.
– Neonatal jaundice: Phototherapy helps jaundice resolve without complications in most newborns.
Seeing your doctor quickly when you notice yellowing eyes gives the best chance for finding reversible causes and proper treatment. Left too long, permanent liver damage can develop and limit treatment options. Monitoring your liver health with regular checkups allows early detection and management of many conditions before jaundice occurs.
Conclusion
Yellowing of the whites of the eyes is a red-flag symptom that should never be ignored. While several causes may be harmless and temporary, jaundice can potentially signal serious illnesses like liver disease, cancer, anemia, and bile duct blockage that need prompt evaluation and treatment. The exact cause is diagnosed via blood tests, imaging, and sometimes biopsy. Specific treatment targets the underlying condition, which may include medication, surgery, or lifestyle changes. If caught early, many causes of jaundice can be successfully cured or managed. But complications like liver failure, vitamin deficiencies, sepsis, and even death can occur if jaundice goes unchecked. Getting assessed urgently when you notice yellow eyes offers the best outcomes. Staying on top of your liver health through checkups, vaccines, and moderating alcohol intake can also help avoid many conditions that lead to jaundice.
