Yellow eyes, medically known as scleral icterus, refers to a discoloration of the whites of the eyes to a yellowish hue. This symptom is not a disease in itself but indicates an underlying medical condition. It arises from an accumulation of bilirubin, a yellowish pigment, in the blood. Elevated bilirubin levels can deposit in various tissues, including the sclera, causing the eyes to appear yellow. Professional medical evaluation is necessary to determine the cause.
Common Causes
Yellow eyes often signal an issue with how the body processes bilirubin, a byproduct of red blood cell breakdown. The liver plays a primary role in this process, converting bilirubin into a water-soluble form that can be excreted. When the liver’s function is impaired, or the excretion pathway is blocked, bilirubin builds up in the bloodstream.
Liver diseases are a frequent cause of yellow eyes because they directly affect the organ responsible for bilirubin processing. Conditions such as hepatitis (viral, alcoholic, or autoimmune) cause inflammation and damage to liver cells. Cirrhosis, a severe scarring of the liver often resulting from chronic hepatitis or alcohol abuse, also compromises liver function. Fatty liver disease, especially non-alcoholic steatohepatitis (NASH), can progress to liver damage and bilirubin elevation. Liver cancer, by directly impairing liver cells or obstructing bile flow, similarly contributes to yellow eyes.
Obstructions in the bile ducts prevent bilirubin from being excreted from the liver into the intestines. Bile ducts are small tubes that carry bile, containing processed bilirubin, from the liver to the gallbladder and then to the small intestine. Common causes of blockages include gallstones, hardened deposits that can lodge in the bile ducts, and tumors, such as those in the pancreas or bile ducts themselves. Strictures, abnormal narrowings of the bile ducts, can also impede bile flow.
Blood disorders can also lead to yellow eyes, particularly those characterized by accelerated red blood cell destruction. In conditions like hemolytic anemia, red blood cells are broken down at an unusually rapid rate. This rapid breakdown releases a large amount of bilirubin into the blood, overwhelming the liver’s ability to process it quickly enough.
Certain medications and exposure to toxins can induce liver damage or interfere with bilirubin metabolism. Some drugs, like acetaminophen in excessive doses, or certain antibiotics, can cause drug-induced liver injury. Exposure to environmental toxins or industrial chemicals can also harm liver cells, impairing their ability to process bilirubin effectively.
Diagnosing Yellow Eyes
A medical professional begins the diagnostic process for yellow eyes by taking a comprehensive medical history and conducting a physical examination. The doctor might ask about recent illnesses, any medications being taken, alcohol consumption habits, and family history of liver disease or blood disorders. During the physical exam, they will observe the skin and eyes for signs of yellowing and may also feel the abdomen to check for liver enlargement or tenderness.
Blood tests are a standard and informative step in diagnosing the cause of yellow eyes. These tests include measuring bilirubin levels, specifically total bilirubin, direct (conjugated) bilirubin, and indirect (unconjugated) bilirubin, to determine the type of bilirubin accumulation. Liver function tests (LFTs), such as alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP), and gamma-glutamyl transferase (GGT), are performed to assess liver cell damage and bile duct obstruction. A complete blood count (CBC) helps identify anemia or other blood cell abnormalities, which could indicate a blood disorder as the underlying cause.
Imaging studies provide visual information about the liver, gallbladder, and bile ducts. An ultrasound is often the initial imaging test, as it can detect gallstones, bile duct dilation, or structural changes in the liver. If further detail is needed, a CT scan or MRI might be performed to get more precise images of these organs and identify tumors or other blockages. More specialized procedures like Endoscopic Retrograde Cholangiopancreatography (ERCP) or Magnetic Resonance Cholangiopancreatography (MRCP) may be used to visualize the bile ducts in detail and sometimes to remove obstructions.
Treatment Approaches
Addressing yellow eyes directly involves treating the underlying medical condition responsible for the bilirubin buildup. There is no single treatment for yellow eyes; the approach is always tailored to the specific diagnosis.
For liver diseases, treatment varies depending on the specific condition. Viral hepatitis may be managed with antiviral medications designed to suppress the virus and reduce liver inflammation. Alcoholic liver disease often requires complete abstinence from alcohol, coupled with nutritional support and medications to manage symptoms. Fatty liver disease is frequently addressed through lifestyle modifications, including dietary changes to reduce fat intake and regular physical activity to promote weight loss. In cases of liver cancer, treatment options can range from surgical removal of tumors to chemotherapy or radiation therapy, depending on the stage and type of cancer.
When bile duct obstructions are the cause, interventions focus on clearing the blockage. Gallstones causing obstruction may be removed surgically, often through a laparoscopic cholecystectomy. Endoscopic procedures, such as ERCP, can be used to remove stones from the bile ducts or to place stents to open narrowed areas. If a tumor is causing the obstruction, surgical removal or stent placement to bypass the blockage may be necessary.
Managing blood disorders, particularly hemolytic anemia, aims to reduce the destruction of red blood cells. Treatment might include corticosteroids to suppress the immune system if it is attacking red blood cells, or blood transfusions to replenish red blood cell count in severe cases. In some instances, a splenectomy, the surgical removal of the spleen, may be considered if the spleen is overly active in destroying red blood cells.
If medications are identified as the cause of liver damage, discontinuing the offending drug is typically the first and most direct step. A doctor will evaluate the necessity of the medication and explore alternative treatments if possible. Close monitoring of liver function tests will follow to ensure bilirubin levels return to normal.
When to See a Doctor
Any instance of yellow eyes in adults warrants prompt medical attention. This discoloration can indicate a serious underlying medical condition that requires timely diagnosis and treatment. Delaying professional medical evaluation could lead to complications or worsening of the condition.
Seeking immediate emergency medical care is particularly important if yellow eyes are accompanied by other concerning symptoms. These can include severe abdominal pain, which might suggest a serious liver or bile duct issue. The presence of fever and chills could indicate an infection. Dark urine and pale stools are also significant signs, as they specifically point to problems with bilirubin excretion. Nausea, vomiting, sudden unexplained weight loss, confusion, and easy bruising or bleeding are additional symptoms that, when present with yellow eyes, necessitate urgent medical consultation.