Updated on  February 21, 2024
3 min read

The Yellowing of the Eyes: What is Scleral Icterus?

Vision Center is funded by our readers. We may earn commissions if you purchase something via one of our links.

What is Scleral Icterus?

Scleral icterus describes the yellowing (jaundice) of the eyes.

Different underlying medical conditions can cause the eyes to yellow. An increase in bilirubin levels causes the yellow hue. However, bilirubin doesn’t accumulate in the sclera (white part of the eye).

The yellowish pigment builds up in the conjunctiva (tissue covering the sclera). This is why the condition is often called conjunctival icterus.  

Your liver is responsible for pulling the bilirubin from your blood. Liver problems or other health-related issues can cause bilirubin levels to rise.

Viral hepatitis is an example of a medical condition that can prevent the liver from performing correctly. 

What Causes Scleral Icterus?

Scleral icterus can indicate initial signs of an underlying condition. It can also precede systemic jaundice, in which yellowing of other body areas occurs. 

However, some healthcare providers may misdiagnose eye yellowing for scleral icterus. You could have prominent subconjunctival fat that results in a yellow hue.

A distinguishing feature of scleral icterus is that jaundice also affects the area near the cornea. 

Scleral icterus could represent the only sign of jaundice on physical examination in people with dark skin. 

What are the Symptoms of Scleral Icterus?

Scleral icterus refers to when your eyes become yellow. However, scleral icterus will not cause symptoms. Rather, symptoms are related to the underlying cause of jaundice.

Possible symptoms you may have with scleral icterus include:

  • Itchy skin
  • Joint aches
  • Fullness in the stomach
  • Fatigue
  • Malaise
  • Fever
  • Changes in urine or stool
  • Appetite loss
  • Nausea
  • Sudden weight loss

When to See a Doctor

Speak with your healthcare provider if you experience scleral icterus or jaundice symptoms. While the condition sometimes doesn’t require treatment, your doctor can diagnose your condition and rule out any possible health problems.  

Scleral icterus often occurs when your bilirubin levels are between 2 to 3 mg/dL. This does not mean your skin or other mucous membranes have also become yellow.

Listen In Q&A Format

Scleral Icterus: Causes, Symptoms & Treatment
Vision Center Podcast

How is Scleral Icterus Diagnosed?

Your healthcare provider will perform multiple tests to determine the cause of scleral icterus. These may include liver function tests and physical examinations.

Furthermore, your doctor may ask a comprehensive series of questions related to your:

  • Use of drugs, alcohol, or other toxic substances
  • Risk factors for hepatitis, such as unsafe sexual practices
  • HIV status 
  • Family history of genetic disorders or hemolytic disorders 
  • Duration of jaundice 

These details will help your doctor rule out various health conditions and reach a proper diagnosis.

How is Scleral Icterus Treated? 

There is no direct treatment for either scleral icterus or jaundice. Treatment options will depend on the underlying eye diseases or health problems causing the yellowing of the eyes and/or skin. 

Conversely, the prognosis of scleral icterus or jaundice varies based on the cause. For example, jaundice due to the resorption of hematomas or Gilbert syndrome will have a better prognosis than malignant biliary obstructions and liver cirrhosis.

What is the Difference Between Icterus and Jaundice?

There is no distinct difference between icterus and jaundice. Both refer to the yellowing of the eyes, skin, and/or mucous membranes due to elevated bilirubin levels. 

However, semantics could cause some people to believe there are differences.

Some healthcare professionals may consider jaundice (from the French root word “jaune” for yellow) as a complication because of an underlying health issue. Icterus, for example, could be a sign of systemic jaundice. 

Regardless, if you develop yellowing of the eyes or other body areas, speak to your healthcare provider. You may require treatment for an undiagnosed health problem. 


Scleral icterus pertains to the yellowing of the eyes. Aside from yellow eyes, you may experience other symptoms related to the underlying health condition. Your healthcare provider will diagnose the cause and provide treatment options if necessary.

Updated on  February 21, 2024
6 sources cited
Updated on  February 21, 2024
  1. Adult Jaundice: Symptoms, Causes, Diagnosis, Treatment & Prevention.Cleveland Clinic, 2018.
  2. Beisel B. “Use of the Term Conjunctival Icterus Instead of Scleral Icterus.Letters to the Editor, American Family Physician, 2005.
  3. Joseph A “Jaundice.StatPearls [Internet]., U.S. National Library of Medicine, 2021.
  4. McGee S. “Jaundice.Evidence-Based Physical Diagnosis (Fourth Edition), Elsevier, 2017.
  5. Mortensen ZQ. “Icterus/Jaundice.EyeRounds, University of Iowa Health Care, 2020.
  6. Tooley AA and Sweetser S. “Clinical Examination: Eyes.” AASLD, John Wiley & Sons, Ltd, 2016.
The information provided on VisionCenter.org should not be used in place of actual information provided by a doctor or a specialist.