Yellow eyes, also known as jaundice, is a condition that causes a yellowish tint to the whites of the eyes or the skin. It occurs when there is excess bilirubin in the blood. Bilirubin is a yellow pigment that is formed by the breakdown of red blood cells. Normally, the liver filters out bilirubin and it leaves the body through stool. But when the liver is not working properly or bilirubin production is too high, it can build up and cause jaundice. There are many possible causes of jaundice in adults which we will explore in this article.
What is bilirubin?
Bilirubin is a yellowish pigment that is formed during the normal breakdown of red blood cells. Here is a bit more detail about bilirubin production:
- Red blood cells transport oxygen from the lungs to tissues throughout the body. They live for about 120 days before they are broken down and replaced.
- When red blood cells break down, the hemoglobin in them is converted into bilirubin.
- Bilirubin is carried in the bloodstream to the liver, where it is conjugated (modified) into a water-soluble form called conjugated bilirubin.
- Conjugated bilirubin is secreted into bile, passed into the intestines, further broken down by gut bacteria, and eliminated in the stool.
This is a normal process that happens continuously to get rid of old red blood cells. Problems arise when there is either too much bilirubin being produced or an issue with the liver processing it.
What causes high bilirubin levels in adults?
There are several possible causes of elevated bilirubin leading to yellow eyes in adults:
Liver diseases
The most common cause of jaundice in adults is liver disease. The liver plays a key role in processing and clearing bilirubin from the body. When the liver is damaged or diseased, it cannot properly do this job. Common liver conditions leading to jaundice include:
- Hepatitis: Inflammation of the liver, often caused by viral infections like hepatitis A, B, and C.
- Cirrhosis: Hardening and scarring of the liver due to long-term alcohol abuse or chronic hepatitis.
- Fatty liver disease: Buildup of fat in liver cells, often caused by obesity, diabetes, or alcoholism.
- Autoimmune disorders: Diseases where the immune system attacks the liver, like primary biliary cholangitis.
- Liver cancer: Growth of malignant tumor in the liver that can obstruct bile flow.
Gallbladder/bile duct problems
Jaundice can occur if there is an obstruction preventing the flow of bile out of the gallbladder or through the bile ducts. Causes include:
- Gallstones
- Inflammation of the gallbladder
- Pancreatic cancer, if the tumor is pressing on bile ducts
- Narrowing or strictures of the bile ducts
When bile cannot drain properly, bilirubin builds up and jaundice develops.
Hemolytic anemia
This refers to conditions where red blood cells are broken down prematurely. The increased destruction of red blood cells leads to overproduction of bilirubin. Types of hemolytic anemia include:
- Sickle cell anemia
- Thalassemia
- G6PD deficiency
- Hereditary spherocytosis
Medications and supplements
Some prescription medications as well as herbal and dietary supplements can cause a drug-induced type of jaundice:
- Antibiotics like amoxicillin-clavulanate
- Anti-seizure medications like phenytoin
- Anabolic steroids and androgens
- Acetaminophen in large doses
- Herbal supplements like pyrethrum and germander
These substances can cause liver toxicity and interfere with bilirubin processing.
Infections
Infections that may cause yellow eyes include:
- Malaria
- Leptospirosis
- Infectious mononucleosis
- Yellow fever
- Dengue fever
Some bacterial, viral, and parasitic infections damage red blood cells, while others directly infect the liver.
Cancer
Cancers originating in the liver or spreading to the liver from other parts of the body (metastasis) can lead to jaundice. Pancreatic cancer and bile duct cancer are two examples. The tumor blocks bile flow and causes bilirubin buildup.
Pregnancy
Some pregnant women develop jaundice in the second or third trimester. Causes include:
- Acute fatty liver of pregnancy
- Preeclampsia affecting the liver
- HELLP syndrome (hemolysis, elevated liver enzymes, low platelets)
- Intrahepatic cholestasis of pregnancy
These conditions impair the liver’s ability to process bilirubin. After pregnancy, the jaundice usually resolves.
Risk factors
Factors that increase the risk of developing jaundice and elevated bilirubin levels include:
- Liver disease such as viral hepatitis, cirrhosis, or fatty liver
- Gallstones or obstruction of the bile ducts
- Hemolytic anemia
- Taking certain medications or supplements
- Advanced age
- Excess alcohol consumption
- Chronic medical conditions like diabetes or obesity
- Pregnancy
- Exposure to toxic chemicals
- HIV/AIDS
- Family history of liver disease
People with these risk factors may want to be screened periodically by a doctor for elevated bilirubin levels. Early detection of jaundice can help identify underlying liver conditions before they progress.
Symptoms
In addition to yellow discoloration of the whites of the eyes, symptoms of jaundice and high bilirubin levels can include:
| Symptom | Description |
|---|---|
| Yellow skin | Yellowish discoloration of the skin and mucous membranes |
| Dark urine | Urine appears dark yellow or brown from excess bilirubin |
| Light stools | Excess bilirubin results in pale or clay-colored stools |
| Itching | Itching of the skin occurs in some cases |
| Fatigue | Feeling tired and sluggish |
| Abdominal pain | Pain or tenderness in the upper right abdomen |
The severity of symptoms often depends on the underlying cause and how high bilirubin levels are elevated. Mild jaundice may cause minimal symptoms.
When to see a doctor
It is important to see a doctor if you develop any signs of jaundice. You should seek medical attention right away if you have:
- Yellowing in the whites of the eyes
- Yellow skin
- Dark urine and light stools
- Itching
- Abdominal pain and swelling
- Fever and flu-like symptoms
- Nausea, vomiting, and diarrhea
Jaundice in adults can indicate a serious underlying medical condition, like liver disease, that needs treatment. Prompt diagnosis and care can help prevent long-term complications.
Some reasons to seek urgent care for jaundice include:
- You have no history of liver disease or prior jaundice episodes
- Jaundice comes on rapidly and severely within a few days
- You have abnormal abdominal swelling and fluid retention
- You have signs of infection like fever and chills
- You have experienced an injury to the abdomen or liver
- You use IV drugs or share needles
- You have recently started new medications
- You have severe nausea, vomiting, or diarrhea
- Your stools are chalky white or you have dark urine
See your doctor promptly if you are pregnant and develop jaundice, as it may signal a serious liver condition.
Diagnosing the cause
To diagnose the cause of jaundice and elevated bilirubin, the doctor will begin with a physical exam, take your medical history, and ask about symptoms. Diagnostic tests may include:
- Liver function tests: Blood tests check levels of bilirubin, liver enzymes, and other markers that indicate how well the liver is working.
- Complete blood count: Checks for anemia and signs of infection.
- Viral hepatitis panel: Blood tests that identify hepatitis A, B, and C infections.
- Abdominal ultrasound: Uses sound waves to create images of the liver and check bile ducts.
- CT scan: Cross-sectional X-ray images giving a detailed view of the liver.
- MRI: Uses magnets and radio waves to generate images of organs and tissues.
- Liver biopsy: Removes a small sample of liver tissue to examine under a microscope.
These tests help pinpoint whether the cause is originating from the liver, gallbladder, blood, or an outside source like medications or toxins.
Treatment options
The appropriate treatment for jaundice depends on the underlying cause:
- For gallstones or bile duct obstruction, surgery may be done to remove gallstones or open up blocked ducts.
- If a medication is causing jaundice, stopping the medication may resolve it.
- Viral hepatitis is treated with antiviral drugs and adopting a healthy lifestyle.
- A blood transfusion can help improve anemia from blood cell defects.
- If an autoimmune disorder is involved, immunosuppressant drugs may be used.
- For cancer, treatment options are based on the type of cancer and may include surgery, chemotherapy, radiation, or liver transplant.
- Alcoholic and non-alcoholic fatty liver diseases are treated by abstaining from alcohol and losing weight.
The doctor will provide specific instructions for treating the underlying disorder leading to jaundice. In serious cases, a liver transplant may be necessary.
Home care and remedies
There are some simple home remedies that may help relieve mild jaundice:
- Drink plenty of fluids, especially water, to stay hydrated.
- Consume vitamin C through citrus fruits, bell peppers, and strawberries.
- Eat small, frequent meals rather than large ones to reduce liver strain.
- Avoid fatty, greasy, processed, and sugary foods which are hard to digest.
- Limit sodium intake.
- Apply a cold compress to itchy areas for relief without scratching.
- Ask your doctor before using over-the-counter medications.
- Rest as much as possible.
- Take care to avoid spreading illness if jaundice was caused by an infection.
While home remedies may help you feel better, it is essential to get medical care to treat the root cause of jaundice. Left untreated, high bilirubin levels can lead to serious complications.
Complications
Without proper treatment, elevated bilirubin levels can cause both short and long-term health problems. Possible complications include:
- Dehydration: Jaundice often causes increased urination leading to fluid and electrolyte imbalances.
- Malnutrition: Poor appetite and nutrient absorption can cause protein and vitamin deficiencies.
- Kernicterus: Bilirubin buildup in the brain tissues, causing brain damage and hearing loss in infants.
- Permanent liver scarring: Untreated infections and liver disorders lead to cirrhosis.
- Liver failure: If large parts of the liver become damaged and die off, liver failure occurs.
- High blood pressure in the portal vein: Results from obstructed blood flow through the liver.
- Itching and scratching can cause skin infections.
- Gallbladder disorders like cholecystitis if bile ducts are blocked.
- Increased risk of liver cancer over time.
That is why prompt diagnosis and treatment are essential whenever jaundice develops. Left unchecked, it has the potential to progress into very serious and even life-threatening complications.
Prevention
There are some steps you can take to reduce the risk of developing jaundice:
- Get vaccinated for hepatitis A and B.
- Wash hands frequently and avoid contact with sick people to prevent infections.
- Limit alcohol consumption and avoid binge or heavy drinking.
- Maintain a healthy weight through diet and exercise.
- Take medications only as prescribed and avoid combining multiple medications without doctor approval.
- Do not use recreational IV drugs or share needles.
- Avoid exposure to toxins like industrial chemicals that could damage the liver.
- Manage existing liver conditions carefully by following up regularly with your doctor.
While some causes of jaundice cannot always be prevented fully, good hygiene, a healthy lifestyle, and proper medication use can reduce your risk substantially.
Conclusion
In summary, yellow eyes or jaundice in adults has several potential causes including liver diseases, gallbladder disorders, hemolytic anemia, infections, cancers, and certain medications. Risk factors include liver disorders, obesity, alcohol abuse, older age, and pregnancy. Symptoms involve yellowing of the skin and eyes, itching, abdominal pain, and changes in urine or stool color. Diagnosis often involves blood tests, imaging tests, and sometimes liver biopsy. Underlying disorders need to be treated to resolve the jaundice and prevent complications like liver failure. Prevention centers around vaccines, hygiene, healthy lifestyle choices, and avoiding medications that could damage the liver. Jaundice is never normal – seek prompt medical care if you develop yellow eyes to get the required treatment.