Yellow Eyes

Yellow whites mean bilirubin, a pigment from the breakdown of red blood cells, has built up in the blood and stained the tissue. The sclera takes it up readily and shows it early, which is why the eyes often yellow before the skin does — and why a doctor looks at the eyes first.

This is a systemic sign rather than an eye disease. The eye itself is working normally; treating it means finding out what the liver, bile ducts or red cells are doing.

• Yellow discolouration of the whites of both eyes
• Yellowing of the skin, often noticed later
• Dark urine and pale stools
• Itching, tiredness, nausea or abdominal pain
• Bruising easily, or unexplained weight loss

Liver disease of any kind — hepatitis, alcohol-related liver disease, cirrhosis, drug reactions. Blockage of the bile ducts by gallstones or a tumour. Haemolysis, where red cells break down faster than the liver can clear the pigment. Gilbert syndrome, a common and harmless inherited variant, causes mild intermittent yellowing under stress or fasting.

Newborn jaundice in the first week is usual and mostly physiological, but it is monitored closely because very high levels are harmful.

This is a general medical work-up, not an eye one: blood tests for liver function, bilirubin and blood count, hepatitis serology, and usually an ultrasound of the liver and bile ducts.

Treatment is entirely of the cause — antivirals for hepatitis, stopping the responsible drug or alcohol, removing gallstones, managing a haemolytic condition. The yellowing fades as bilirubin falls. Gilbert syndrome needs nothing at all. Yellow patches confined to a wedge on the white, rather than the whole sclera, are usually pinguecula or pterygium and are a separate, purely ocular matter.