Yellowing of the whites of your eyes, medically known as scleral icterus, often suggests an underlying health concern. This discoloration occurs when a yellow pigment accumulates in the body. While it can indicate jaundice, it is a symptom, not a disease, requiring medical attention.
The Role of Bilirubin
The yellow tint in the eyes stems from bilirubin, a natural byproduct of red blood cell breakdown. This bilirubin is initially unconjugated and not water-soluble, so it binds to a protein called albumin for transport to the liver.
Once in the liver, unconjugated bilirubin undergoes conjugation, where it is made water-soluble. This conjugated bilirubin is then excreted from the liver as a component of bile, a digestive fluid. Bile travels through bile ducts into the digestive tract, eventually being eliminated from the body primarily in stool. If bilirubin production exceeds the liver’s processing capacity or its excretion pathway is disrupted, it accumulates in the bloodstream, leading to hyperbilirubinemia, which manifests as yellowing of the eyes and skin.
Common Causes of Yellow Eyes
Several medical conditions can lead to elevated bilirubin levels and, consequently, yellow eyes. These conditions generally affect the liver’s ability to process bilirubin, obstruct bile excretion pathways, or cause excessive red blood cell breakdown.
Liver conditions frequently cause yellow eyes because the liver is central to bilirubin metabolism. Hepatitis, inflammation of the liver, can be caused by viral infections (such as hepatitis A, B, or C), autoimmune disorders, or certain medications. This inflammation impairs the liver’s capacity to process and eliminate bilirubin effectively. Cirrhosis, characterized by scarring of the liver, and non-alcoholic fatty liver disease also hinder the liver’s function, preventing it from adequately filtering bilirubin from the blood.
Another significant cause involves blockages in the bile ducts, which transport bile from the liver and gallbladder to the small intestine. Gallstones are a common culprit, physically obstructing these ducts and preventing bile, rich in bilirubin, from draining properly. Tumors in or near the bile ducts or pancreas can also create blockages, as can inflammation or scarring of the ducts.
Blood disorders, particularly those that cause an accelerated breakdown of red blood cells, can overload the liver with bilirubin. Hemolytic anemia, for example, results in the premature destruction of red blood cells, leading to a rapid release of bilirubin that the liver cannot process quickly enough. Conditions like sickle cell anemia and thalassemia are examples of inherited disorders that can lead to hemolytic anemia.
Certain medications can also induce yellow eyes as a side effect by affecting liver function or bile flow. Drugs such as acetaminophen, especially in high doses, and nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen can cause liver injury. Some antibiotics, including amoxicillin-clavulanate, as well as statins and certain antipsychotic medications, have been linked to liver issues or cholestatic jaundice, where bile flow is impaired.
When to Seek Medical Advice
Any noticeable yellowing of the eyes should prompt a medical evaluation. This symptom indicates a bilirubin imbalance that often requires professional diagnosis and treatment. Delaying medical advice could allow an underlying condition to progress, potentially leading to more serious health complications.
It is important to seek prompt medical attention if yellow eyes are accompanied by other symptoms. These can include fever, abdominal pain, unexplained weight loss, dark urine, pale or clay-colored stools, persistent nausea, vomiting, or significant fatigue.
What to Expect at the Doctor’s Office
When you consult a doctor for yellow eyes, the diagnostic process typically begins with a thorough physical examination and a review of your medical history. The doctor will look for other signs of liver disease or related conditions. This initial assessment helps guide further investigation into the cause of the elevated bilirubin.
Blood tests are a standard part of the diagnostic workup. These tests measure bilirubin levels, indicating how much of the pigment is present in your blood. Liver function tests are also performed to assess the health and performance of your liver, while a complete blood count (CBC) can identify conditions like anemia, which might be contributing to the yellowing. Depending on these results, imaging tests such as an ultrasound, CT scan, or MRI may be ordered to visualize the liver, gallbladder, and bile ducts for abnormalities like blockages or tumors. In some instances, a liver biopsy might be necessary to obtain a tissue sample for detailed analysis. Treatment for yellow eyes is always directed at addressing the specific underlying cause, rather than merely treating the symptom itself.