What is Scleral Icterus?
Scleral icterus is a condition where there is yellowing of the whites of the eyes. This is most commonly seen in patients who have liver disease. The yellow color of the eyes in patients having scleral icterus can range from a muddying to a bright yellow or even an orange discoloration. There is no change in the vision due to scleral icterus. Scleral icterus is not a disease in itself, but a symptom of an underlying medical condition. When the underlying problem is resolved, then the scleral icterus is also resolved.
Classification of Scleral Icterus
Depending on where the problem has occurred with processing of the bilirubin, classification of the discoloration of the eyes or scleral icterus is done as:
- Pre-hepatic scleral icterus.
- Hepatic scleral icterus.
- Post-hepatic scleral icterus.
Causes & Pathophysiology of Scleral Icterus
Bilirubin is a pigment which is excreted in bile and urine and is processed by the liver. What happens in people who have scleral icterus is that the body’s processing system for bilirubin breaks down. When the red blood cells break down, they produce bilirubin as a byproduct. It travels via the blood circulation to the liver, where it gets converted so that it can be expressed by the body. In some individuals, there can be a problem which can occur along the route to the liver or in the liver, or during the process of excreting bilirubin from the body. This causes bilirubin to keep on circulating in the blood where it eventually gets deposited in the conjunctiva (membrane covering the whites of the eye) resulting in the yellow appearance of the eyes known as scleral icterus. It can also get deposited in the skin, causing yellowing of it along with the eyes (jaundice). This yellowing discoloration of the eyes (scleral icterus) and skin is known as jaundice, the cause of which can be inflammation or infection of the liver, liver cancer, bile duct obstructions, alcoholism and certain medications. Sometimes, newborn infants also develop jaundice. When a person develops jaundice, it is important to determine the cause of it to start the treatment accordingly.
Top 8 Medical Conditions Which Can Cause Scleral Icterus
- Biliary colic.
- Alcoholic hepatitis.
- Gall bladder disease.
- Epstein Barr infection.
- Gallstones.
- Hepatitis (A and B).
- Viral hepatitis.
- Mononucleosis.
Uncommon Medical Conditions Which Cause Scleral Icterus
- Esophageal varices.
- Cirrhosis.
- Hepatitis C.
- Jaundice in children.
- Hepatomegaly.
- Injury to the liver.
- Sickle cell anemia.
- Neonatal jaundice.
40 Rare Medical Conditions Which Can Cause Scleral Icterus
- Acetaminophen overdose.
- Boutonneuse fever.
- Biliary atresia.
- Budd-chiari syndrome.
- Cholangitis.
- Cholangiocarcinoma.
- Chronic persistent hepatitis.
- Crigler-Najjar syndrome.
- Colorectal cancer.
- Dubin-Johnson syndrome.
- Echinococcosis.
- Erythroblastosis fetalis.
- Galactosemia.
- Extraintestinal amebiasis.
- Gilbert’s disease.
- Gallbladder cancer.
- Glucose-6-phosphate dehydrogenase deficiency
- Glucagonoma.
- Hemochromatosis.
- Hemolytic anemia.
- Hemoglobin C disease.
- Hepatitis D.
- Hepatitis E.
- Kernicterus.
- Histoplasmosis.
- Leptospirosis.
- Malaria.
- Liver cancer.
- Pancreatic cancer.
- Porphyria cutanea tarda.
- Paroxysmal nocturnal hemoglobinuria.
- Primary biliary cirrhosis.
- Scurvy.
- Rotor’s syndrome.
- Thalassemia.
- Spherocytosis.
- Thrombotic thrombocytopenic purpura.
- Wilson’s disease.
- Toxoplasmosis.
- Yellow fever.
Diagnosis of Scleral Icterus
A number of tests are done to check the levels of bilirubin in the blood along with liver enzymes. In some cases, patients have naturally dark sclera, where it can be difficult to differentiate or diagnose scleral icterus. In such cases, self reporting from a patient is useful, or observation from friends and family is useful, as they can more confidently differentiate or tell if the apparent discoloration is normal or not. Usually, individuals who have a darker skin tend to have a cream colored scleras, rather than having white scleras.
Treatment for Scleral Icterus
Treatment depends on the underlying problem which is causing scleral citrus. As mentioned previously, scleral icterus is not a disease in itself, but a symptom of an underlying medical condition. When the underlying problem is resolved, then the scleral icterus is also resolved. There are some conditions which cause jaundice and can be easily resolved with treatment; whereas there are some conditions, which can only be controlled or managed. Patients, who are having liver failure, need liver transplant; after which the scleral icterus or jaundice gets resolved. Treatment in newborns who have jaundice or sleral icterus comprises of phototherapy sessions which helps in gradual return of the normal color of the eyes and skin.
