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Scleral Icterus vs Jaundice: Commonly Confused

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While similar, jaundice and scleral icterus are two separate conditions. Scleral icterus refers to just the yellowing of the eyes and typically precedes the systemic development of jaundice throughout the body.

Scleral icterus and jaundice are commonly confused because they share similar causes, symptoms, and treatment options. Correctly identifying the extent of bilirubin buildup in the body will lend to proper diagnosis of the underlying conditions and their treatments.

Jaundice occurs when bilirubin levels in the body get too high. The result is a yellowing of the skin, eyes, and mucous membranes.

Jaundice is caused by disruptions to the proper processing of bilirubin. Conditions that interfere with bilirubin production and processing include viruses, autoimmune disorders, and gallbladder and liver disease, among others.

Scleral icterus is also caused by increased bilirubin levels in the body. Also called conjunctiva icterus, scleral icterus refers to the yellowing of the eyes.

What Jaundice Looks Like

Jaundice can occur in babies, children, and adults. When someone has jaundice, they have high levels of bilirubin, a yellow-orange bile pigment, in their system. Excess levels of bilirubin cause the skin, whites of the eyes (sclera), and mucous membranes to turn yellow.

Jaundice is most recognizable by the yellowish color of the skin and eyes. Additional symptoms can accompany the condition. Short-term instances of jaundice that are usually caused by an infection can include the following symptoms:

  • Fever
  • Chills
  • Stomach pain
  • Skin color changes
  • Urine that is dark in color
  • Stool that is clay colored
  • Flu-like symptoms

The severity of the above symptoms varies depending on the cause of jaundice and how swiftly the disease progresses.

What Causes Jaundice?

Jaundice is caused by problems that occur in bilirubin production. There is typically an underlying condition, such as a virus or infection, causing jaundice to develop.

Causes of jaundice include the following:

  • Viruses, such as hepatitis A, B, or C
  • Alcohol consumption
  • Genetic metabolic defects
  • Medicines, including acetaminophen toxicity, penicillin, oral contraceptives, chlorpromazine, and anabolic or estrogenic steroids
  • Gallstones
  • Autoimmune disorders
  • Swollen gallbladder
  • Gallbladder or pancreatic cancer
  • Liver disease

For some people, the symptoms of jaundice are minor. They are more severe for others.

Typically, jaundice does not require treatment. The underlying causes of jaundice need to be addressed. Likewise, uncomfortable symptoms associated with jaundice can be treated.

What Is Scleral Icterus?

Scleral icterus is often used to describe jaundice in the eyes, though this label is not entirely accurate. The conjunctiva (mucous membrane) of the eye, rather than the sclera, is what actually takes on the yellow color as bilirubin levels rise.

Identifying scleral icterus is important for diagnosing underlying medical conditions. Changes in the eyes are associated with a wide range of liver diseases.

Like jaundice, scleral icterus produces a yellowing of the eyes and can be a warning sign of a more serious underlying condition. The majority of people affected by scleral icterus include infants and older adults.

Causes of scleral icterus vary according to age.

  • In newborns: Immature liver, absorption of bilirubin from the intestines, decreases in bowel movements, inherited genetic conditions, and viral hepatitis are potential causes.
  • In adults: Bile duct obstruction, liver dysfunction, cholecystitis, gallstones, pancreatic cancer, and viral hepatitis are potential causes.

As with jaundice, when bilirubin levels get too high, the above symptoms can occur. The severity of the symptoms vary based on the individual’s condition.

While treatment is not always necessary, it is important not to ignore signs of scleral icterus. Almost half of all scleral icterus cases indicate the presence of an underlying disease.

What Is the Difference?

Scleral icterus and jaundice share symptoms and causes, but they are two distinct conditions.

Scleral icterus often precedes the development of systemic jaundice. The yellowing of the eyes is often the first sign that bilirubin levels are off and an underlying condition is present.

The eyes are often the first location to take on a yellowish color when bilirubin levels get too high. Yellowing of the eyes is noticeable at bilirubin levels of 2-3 mg/dL, while yellowing of skin becomes noticeable at 4-5 mg/dL.

Scleral icterus is also often the initial symptom of jaundice. There are few instances where only scleral icterus occurs. While most cases are early signs of jaundice, scleral icterus can occur on its own when:

  • Subconjunctival hemorrhage produces excess bilirubin at the location of an injury, similar to when a yellow bruise occurs.
  • Choroidal hemorrhage occurs following ocular surgery.

Prompt and accurate diagnosis of scleral icterus verse jaundice is important for proper treatment and referrals to be made. In both cases, the conditions themselves can typically not be treated, but the underlying conditions that are causing the yellowing of the eyes or skin can be addressed.

Why Scleral Icterus & Jaundice Are Commonly Confused

Scleral icterus and jaundice are commonly confused because their causes, symptoms, and treatments frequently overlap. Both conditions present the same visual symptoms, so it can be difficult to determine exactly which medical ailment you have.

No matter which condition you have, it is important to seek medical care as both conditions are frequently indicators for more serious underlying problems. In many cases, yellowing of the eyes and skin may be the first warning sign that something else is off within your body.

Scleral icterus and jaundice themselves are rarely treated directly. Proper diagnosis of any underlying health conditions and diseases will allow for appropriate treatment of your health problems. You can then reduce the buildup of bilirubin levels in your system that is causing your eyes and skin to take on a yellow hue.


  1. Adult Jaundice. (July 2018). Cleveland Clinic.
  2. Clinical Examination: Eyes. (June 2016). American Association for the Study of Liver Disease.
  3. Jaundice and Cholestasis. (November 2020). Amboss.
  4. Scleral Icterus: What Is It, Causes, and More. (August 2020). Osmosis.
  5. Yellow: Proceed With Caution. (November 2015). Review of Optometry.

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