Yellow eyes: Causes and treatment of conjunctival icterus

Are your eyes starting to look yellow? The cause may be jaundice, some medications or a host of medical conditions, some very serious.

This article gives you the facts you need to know about yellow eyes — and what you can do about them.

What causes yellow eyes?

The sclera (white of the eye) should always look, well, white. If this part of your eye is red or discoloured, it's time to see an optician to determine what's causing the change in colour.

One type of discolouration of the front of the eye is conjunctival icterus, which is the medical term for yellow eyes. (Sometimes, the term scleral icterus also is used to describe yellow eyes.)

Yellow eyes generally are a symptom of jaundice, which is a discolouration of the skin and eyes caused by elevated levels of a pigment called bilirubin.

Jaundice occurs in newborns, children and adults; although its cause generally differs by age group. While not a disease in and of itself, jaundice is a sign that the liver, gallbladder and bile ducts are not functioning as they should.

One function of the liver is to rid the body of bilirubin, an orange-yellow waste compound made up of old or abnormal red blood cells.

Under normal circumstances, the liver filters bilirubin from the blood, forming a fluid called bile that flows through bile ducts to the adjacent gallbladder, where it is stored and eventually excreted by the body.

When the liver is compromised and there is a buildup of bilirubin in the blood, and it shows up as a yellow tint to the eyes and skin. Higher concentrations of bilirubin yield a brown shade.

The onset of jaundice is gradual and may go unnoticed in the beginning, but it typically shows up first in the whites of the eyes.

“Because the whites of the eye do not contain the pigment found in skin, the yellow discolouration tends to be more noticeable,” says Tammy Than, OD, FAAO, and chairwoman of the American Academy of Optometry’s Communications Committee.

She adds that while jaundice changes the colour of the eyes, it does not impact vision.

Conditions associated with yellow eyes

Jaundice is relatively common in newborn infants.

According to the Centers for Disease Control and Prevention (CDC), about 60% of all babies develop jaundice. Infants born prematurely are at particular risk because their livers aren’t mature enough to process bilirubin.

Mild cases of infantile jaundice generally clear up on their own — only about one in 20 affected infants require intervention. The standard treatment for moderate jaundice is light therapy (phototherapy) to reduce bilirubin levels, and recovery usually is quick.

Jaundice is far less common in older children and adults. In these cases, more serious underlying conditions requiring medical treatment usually are suspected. As with newborns, the liver is the first focus when jaundice occurs in children and adults.

Infection or inflammation of the liver (hepatitis) damages the organ and affects its ability to process bilirubin properly, resulting in hepatocellular jaundice.

Autoimmune diseases that attack the body’s immune system can also cause hepatitis. Hepatitis A, B, and C viruses can infect liver cells, causing either acute (short-lived) or chronic (long-term) hepatitis and yellow eyes.

Sometimes one or more of the ducts that carry bile from the liver to the gallbladder for storage become blocked by gallstones. When the bile cannot flow properly, it builds up in the blood. This condition is known as obstruction jaundice.

Cirrhosis, a late stage of scarring of the liver, reduces the liver's ability to filter bilirubin. Cirrhosis is caused by many forms of liver disease, including hepatitis, non-alcoholic fatty liver disease and chronic alcoholism — all of which can cause yellow eyes.

Other medical conditions that can cause yellow eyes include:

• Acute pancreatitis, or infection of the pancreas.

• Some cancers, including cancer of the liver, pancreas and gallbladder.

• Hemolytic anemia, a congenital blood disorder that occurs when the blood lacks healthy red blood cells.

• Malaria, a mosquito-borne blood infection.

• Certain blood disorders that affect the production and lifespan of red blood cells, including sickle cell anemia.

• Rare genetic disorders that affect the way the liver processes bilirubin.

Specific medications — including over-the-counter acetaminophen (when taken to excess) and prescription drugs like penicillin, oral contraceptives, chlorpromazine and anabolic steroids — also can cause yellow eyes.

Pinguecula: Not yellow eyes, but …

Another condition sometimes associated with yellow eyes is pinguecula (plural: pingueculae).

A pinguecula is a yellowish growth that can develop atop a portion of the sclera, giving this part of the eye a yellow appearance.

The entire eye doesn’t turn yellow, only the part covered by the pinguecula.

Pingueculae are thought to be caused by too much exposure to UV rays from the sun. If a pinguecula becomes large and bothersome, the yellowish growth can be surgically removed.

Treatment of yellow eyes

Treatment of yellow eyes focuses on the underlying medical condition.

“The yellowing of the eyes itself is not treated, but once the condition that is causing the increased bilirubin is treated, the yellow discolouration of the eyes should get better,” she says.

While yellow eyes may be the most visible sign of certain conditions, other symptoms that accompany discolouration of the eyes also are important to determining the nature of the health problem.

Accompanying symptoms might include itchy skin, fullness in the stomach, fatigue, fever, pale stools, dark urine, loss of appetite, nausea and sudden weight loss.

The best treatment of yellow eyes is determined by a number of tests, including one that measures the amount of bilirubin in the blood, a complete blood count and other liver tests.

The test results, along with a review of symptoms, medical history, a physical exam and possibly imaging tests, will help determine the proper diagnosis.

If the underlying cause of yellow eyes is found to be an infection like hepatitis C or malaria, antibiotics, anti-fungal or anti-viral medications may be prescribed.

If alcohol or drug use are part of the diagnosis, giving up those substances will start the healing process.

Diet also can play an important role. The liver processes and metabolises most digested nutrients, and it works harder when foods are difficult to digest. This includes large amounts of refined sugars, salt and saturated fats.

People with jaundice are advised to stay well-hydrated and to eat more liver-friendly foods — fruits and vegetables, whole grains, lean proteins, nuts and legumes.

As the liver begins to heal with treatment, the jaundice and yellow eyes will subside.

In some cases, surgery may be necessary to correct a contributing factor like a blocked bile duct.

Yellow eyes? See an optician

If you suspect you are developing yellow eyes, see an optician immediately.

After thoroughly examining your eyes, your optician might refer you to an internist or other physician if an underlying medical condition is suspected.

Yellow eyes should not be ignored. If liver disease or other medical condition is the underlying cause, prompt diagnosis and treatment is needed to prevent serious complications, including organ damage.

WORRIED ABOUT YOUR YELLOW EYES? YOU SHOULD BE: Find an optician near you and schedule an appointment as soon as you can.

Page published on Tuesday, 23 June, 2020