It's a bit scary when you look in the mirror or when someone tells you that the whites of your eyes are yellow, isn't it? In fact, this can often be the first sign that there is something wrong with our bodies, especially the liver. So let's talk about this yellowing of the eyes, which is medically called `(Scleral Icterus)`, in simple terms.
What exactly is Scleral Icterus?
Simply put, `Scleral Icterus` is when the white part of our eyes, that is, the part we call the `(Sclera)`, looks yellow. But there is something else here. It is not the sclera itself that is actually yellow. It is the part above it, which is a very thin, transparent membrane called the `(Conjunctiva).` When this membrane turns yellow, the yellow color is clearly visible because of the white part of the sclera underneath.
Many people also call it `(Jaundice)`. There is nothing wrong with that, but the word `Jaundice` is a bit broad. It refers to yellowing of the eyes as well as yellowing of the skin. However, `Scleral Icterus` is a condition that specifically affects the eyes .
Why do our eyes turn yellow? The story of bilirubin
The main reason for this yellow color is the increase in the yellow chemical compound called bilirubin in our blood. We call this condition ``Hyperbilirubinemia``.
Think about it, the red blood cells in our body also have a lifespan. Bilirubin is produced when these old red blood cells break down. Normally, what should happen is that our liver acts like a filter, filtering this unnecessary bilirubin from the blood, combining it with bile and directing it to the digestive process. Finally, that bilirubin is excreted from the body with feces.
However, if this bilirubin cannot be removed from the blood properly, either due to a problem with the liver or for some other reason, it starts to accumulate in the blood. This accumulation of bilirubin is what turns the eyes and skin yellow.
The reason why this color change in the eyes is first noticed is that bilirubin is easily absorbed and deposited in the tissue of the eye called the ``Conjunctiva.`` Because of the white background underneath, even a small level of bilirubin is easily visible to us.
What are the main causes of elevated bilirubin levels?
There can be a number of reasons why bilirubin levels are elevated and the eyes may turn yellow. Some are simple, but some can be a little more serious. So it's important to be aware of this.
| Cause | A simple explanation |
|---|---|
| Liver-related diseases | Conditions such as liver damage due to alcohol ( cirrhosis ), viral infections (Hepatitis A, B, C), and autoimmune hepatitis . |
| Gallbladder and pancreas diseases | Conditions such as gallstones , bile duct strictures , or pancreatitis . |
| Infections | Leptospirosis , viral fevers such as dengue, severe infections that spread throughout the body ( sepsis ), and parasitic infections (e.g. Schistosomiasis ). |
| Drugs and toxins | Overuse of certain medications (e.g. steroids, some antibiotics) and painkillers such as Acetaminophen (Panadol). Some traditional herbs and toxins such as agrochemicals can also be causes. |
| Genetic diseases | Inherited diseases such as Sickle Cell Disease and Gilbert's Syndrome that affect bilirubin metabolism. |
| Lumps and tumors | Obstruction of bile flow due to normal or cancerous tumors in the liver, gallbladder, or related areas. |
| Neonatal Jaundice | Because the liver of a newborn is not fully developed, it is normal for the eyes to become yellow in the first two weeks. However, in some cases, this can be serious. |
How is it treated?
The most important thing to understand here is that `Scleral Icterus` is not a disease, but a symptom . Therefore, the treatment is not for the yellowing of the eyes; it is for the underlying condition that caused it.
For example, if your eyes are yellow due to gallstones, you will be treated to remove the stones. If it is a liver infection, you will be treated for that. To find the cause, your doctor may do blood tests, scans, etc. So , it is best to seek medical advice rather than self-treating.
What happens if you ignore yellow eyes?
Yellowing of the eyes is not dangerous in itself. But it is a warning sign . If left untreated, the level of bilirubin in the blood can increase further and even affect the brain. This is a very dangerous condition.
- This condition in newborns is called ``Kernicterus'' and can cause permanent brain damage.
- This condition in adults is called ``Hepatic Encephalopathy'' and can cause memory loss, confusion, and even coma.
Both of these situations require emergency medical treatment .
When to see a doctor or go to the ETU immediately
If you notice that your eyes are turning yellow, make an appointment to see a doctor as soon as possible. However, if you have any of the following symptoms along with your yellow eyes, go to a hospital's Emergency Department (ETU) immediately.
| Symptoms that require urgent attention | |
|---|---|
| ⚫ Severe or persistent stomach pain | ⚫ Fever |
| ⚫ Persistent vomiting | ⚫ Dizziness or loss of consciousness |
| ⚫ Abdominal bloating or water retention | ⚫ Confusion, drowsiness, or memory loss |
A little advice
Sometimes the color of the lights in our environment (e.g. yellow bulbs) can also cause our eyes to appear yellow. So if you have any doubts, go to a well-lit, natural lighted area and look in the mirror. That way, you can be sure of the exact color difference.
Can this situation be prevented?
Although it cannot be completely prevented, there are several things we can do to reduce the risk.
- Control alcohol: Limiting alcohol consumption can greatly reduce damage to the liver.
- Get vaccinated: Protect yourself by getting vaccinated against diseases that affect the liver, such as Hepatitis A and B.
- Be careful with medications: Do not take unnecessary medications, herbs, or supplements without consulting a doctor. Taking more than the recommended dose of medications, especially Acetaminophen (Panadol), can damage the liver.
- Get an annual medical checkup: Even a routine blood test can detect changes in liver function before symptoms appear.
Take-Home Message
- Scleral icterus (yellowing of the whites of the eyes) is not a disease, but a symptom of an underlying condition.
- The main reason for this is an increase in bilirubin levels in the blood. This can often be caused by a liver problem.
- If you notice yellowing of the eyes, don't panic, but don't ignore it either. See a doctor as soon as possible.
- If you have other symptoms such as severe stomach pain, fever, or confusion, go to a hospital's Emergency Department (ETU) immediately.
- Treatment depends on the underlying condition causing the yellow eyes. Therefore, it is essential to seek medical advice for proper diagnosis and treatment.
👩🏽⚕️ Additional questions (FAQs)
💬 What is the dangerous condition of an enlarged spleen (Enlarged Spleen / Splenomegaly)?
The spleen is a small organ that is usually located on the left side of our chest, under the rib cage/behind the stomach, that filters blood/destroys old red blood cells (it is usually smaller than your thumb). But 'Enlarged Spleen' is a condition in which this organ is abnormally swollen and can be felt below the left rib cage (LUQ)! This is the biggest warning sign of a serious blood-related disease in the body.
💬 What are the main causes of an abnormally large spleen on the left side?
There are 3 main causes of this: 1) 'Leukemia / Lymphoma' - In this case, the spleen becomes enlarged because the cancer cells fill it. 2) 'Liver Cirrhosis' - When the blood flow through the liver is blocked, that blood fills the veins of the spleen (Portal hypertension) and it swells. 3) Malaria / Dengue or jaundice (Malaria / EBV Infections) and diseases in which red blood cells are abnormally dissolved (Hemolytic anemia) also inevitably cause this.
💬 When there is a lump/enlarged spleen under the left rib cage, what are the 'life-threatening/emergency situations' that require immediate hospital admission?
This is a disease that requires a doctor to see (you need to go for a CT Scan). But the biggest and most serious danger! 1) If you suddenly experience 'severe pain like an unbearable knife stab (Severe LUQ pain - Splenic Rupture)' below the left rib cage and that pain spreads to the left shoulder (Kehr's sign) and if you become dizzy and lose consciousness, it is definitely a 'spleen rupture'! This can cause bleeding and death within minutes, so you must be hospitalized without delay!
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