What are yellow eyes?
Yellow eyes occur when the whites of the eye (sclera) turn yellow (called scleral icterus). It is a sign of jaundice, which is a symptom of an underlying condition, often of the liver.
Your eyes turn yellow when there’s a buildup of bilirubin. Bilirubin is an orange-yellow substance that’s made during the normal breakdown of red blood cells. It is usually eliminated by your body. But if this process is slowed, bilirubin accumulates in your tissues, including the eyes, turning them yellow.
Diseases that can cause high levels of bilirubin include anemia, viral hepatitis, and liver damage from excessive alcohol use. Many infants have yellow eyes and skin, called neonatal jaundice, in their first few days of life.
You should always see your doctor if your eyes turn yellow. Treatments include artificial tears, quitting drinking, and medications like antiviral drugs.
Words or expressions I expect to hear: “I feel itchy and feel like vomiting” or “I am nauseated all the time and my belly has been swollen recently,” which can be a sign of liver disease. Alternatively, I expect to hear: “I have eaten raw oysters” or “I traveled to a remote location where I wasn’t sure If the water was purified.”—Dr. Steven Yeh
1. Viral hepatitis
Viral hepatitis causes your liver to become inflamed. There are several types of viruses that cause hepatitis (hepatitis A, B, C, etc.), though the symptoms are usually similar. You can get hepatitis A from consuming contaminated food or water, which may occur when traveling. Hepatitis B and C are spread through sex and sharing needles or syringes with an infected person.
Symptoms of viral hepatitis range from mild to severe. Severe viral hepatitis can lead to liver failure in some cases. When liver damage develops rapidly, you may also experience confusion, sudden yellowing of the skin and eyes, and problems with blood clotting.
Treating viral hepatitis
Treatment varies depending on the type of virus that caused your hepatitis. Hepatitis A usually clears up on its own, though you may need intravenous fluids if you have severe symptoms. Fever-lowering medications and rest are also recommended. If you have hepatitis B or C, your doctor will prescribe antiviral medications.
Drinking too much alcohol damages the liver and can lead to cirrhosis, or scarring of the liver, over time. As cirrhosis progresses, scar tissue continues to build, making it difficult for the liver to function properly. When the disease becomes severe, it can be life-threatening.
Unless cirrhosis is caught and treated early, liver damage usually can’t be reversed. Your doctor will recommend treatment for alcohol dependency, such as a stay at a hospital or rehabilitation clinic. You may also need to be treated for nutritional deficiencies, which are common among people who drink too much. A liver transplant is sometimes necessary, but you must have stopped drinking alcohol to be eligible for surgery.
- Yellow eyes
- Shortness of breath with exertion
- Feeling faint
- Pain crises (if you have sickle cell anemia)
Anemia occurs when your level of red blood cells, which carry oxygen to your body’s tissues, is too low. Your eyes may turn yellow if your anemia is caused by something that leads to a breakdown of red blood cells. This is called hemolysis. It can occur in several types of anemia, such as sickle cell anemia, autoimmune hemolytic anemia, and anemia caused by infections (such as malaria).
Treatment depends on the type of anemia you have. For example, treatment of sickle cell anemia may include drinking plenty of water, avoiding triggers like stress and, in severe cases, blood transfusions.
Autoimmune hemolytic anemia may require drugs that suppress your immune system. Infections can be treated with medications such as antimalarial medications for malaria.
4. Subconjunctival hemorrhage
- Yellow eyes
- Recent history of red or purple spot on your eye
- Eye irritation and discomfort
- Mild pain
A subconjunctival hemorrhage is a broken blood vessel in your eye. It starts as a red or purple spot on the white part of the eye, and eventually turns yellow as the blood cells are broken down. It usually takes 5 to 7 days for the spot to go away.
These can be caused by sneezing, coughing, vomiting, or trauma to the eye (getting a foreign body stuck in it). Risk factors include diabetes, high blood pressure, and taking blood-thinning medications.
Treating subconjunctival hemorrhage
Subconjunctival hemorrhages usually go away on their own. But you can treat irritation and pain with artificial tears as your eye heals. See your doctor if the yellowing lasts longer than 7 to 10 days or if your other eye turns yellow.
5. Neonatal jaundice
- Yellow eyes
- Yellow skin
Neonatal jaundice is a common problem that affects infants during their first few days of life. Infants produce more bilirubin than adults, and sometimes their liver can’t remove it quickly enough. The condition can also be caused by damage to the liver. Neonatal jaundice is more common in preterm babies and those who are breastfed.
Neonatal jaundice may affect more than 80% of newborns, according to a study in the journal American Family Physician. It’s usually not dangerous, but in a small number of infants, bilirubin can get too high, which may lead to serious complications (such as seizures) if not treated.
Treating neonatal jaundice
Treatment of neonatal jaundice may include phototherapy in the hospital and more frequent feedings. If the condition is severe, blood transfusions may be necessary.
- Yellowish nodules on the surface of the eyes
- Eye irritation or discomfort
- Shortness of breath in patients (when sarcoidosis affects the lungs)
- Painful or achy joints
Sarcoidosis is an autoimmune condition that develops when inflammatory cells (granulomas) collect in your body’s tissues. It typically occurs in the lungs and lymph nodes, but it can affect the eyes and the surface (conjunctiva) of the eyes. This is called ocular sarcoidosis.
People who have the condition are more likely to develop a type of eye inflammation called uveitis, which can be serious and lead to permanent vision loss.
The cause of sarcoidosis is unknown. Genetics may play a role, but it may also be triggered by bacteria, dust, viruses or chemicals.
Ocular sarcoidosis is treated by an ophthalmologist. The doctor may recommend topical steroids (eye drops). You may need oral steroids if sarcoidosis is affecting other organs, such as the lung or skin. You may also need to take medications that suppress your immune system.
Other possible causes
A number of conditions may cause yellow eyes, including:
- Lymphoma around the eye
- Liver infection or disease
- Cancer of the liver, pancreas, or gallbladder
- Other types of anemia
An eye doctor is helpful for when either the right or left eye is yellow. But for when both eyes are yellow, a general medical doctor is the best way to proceed (e.g., family practice, internal medicine specialists with referrals as needed). —Dr. Yeh
When to call the doctor
You should see your doctor if:
- You have yellow eyes and symptoms such as weakness, fever, nausea, vomiting.
- You think you may have consumed contaminated food or beverages.
- Have a history of alcohol abuse
- Both eyes have turned yellow.
- One eye turns yellow and hasn’t returned to its normal color within 24 to 48 hours.
Should I go to the ER?
Go to the ER if you have yellow eyes and any of these symptoms:
- Moderate to severe nausea or vomiting
- Abdominal pain
- High fever
- Shortness of breath
One of the most common misconceptions is that yellow eyes can clear up on their own with drops or time. —Dr. Yeh
- You can try artificial tears to reduce irritation.
- Other causes of yellow eyes should be treated by addressing the underlying condition that caused them. For example, people with sickle cell anemia should avoid triggers including stress, infection, dehydration.
- People with alcoholic liver disease should stop drinking and may benefit from alcohol rehabilitation programs and counseling.
Steven Yeh, MD, is a board-certified ophthalmologist at Emory University School of Medicine's Emory Eye Center, where he also holds the M. Louise Simpson Endowed Professorship in Ophthalmology and directs the Uveitis and Vasculitis Service. A vitreoretinal physician and surgeon, Dr. Yeh's areas of expertise include advanced diagnostics for the care of adult and pediatric uveitis, age-related macular degeneration, diabetic retinopathy, ocular trauma, retinal vascular disease, retinal detachment surgery, and autoimmune conditions that can affect the eyes. He has worked with the NIH and World Health Organization to serve on the front lines of the Ebola crisis in the U.S. and Africa, pursue clinical research interests, and ultimately build a program around infectious diseases of the eye. Internationally recognized for his clinical expertise, teaching, and research, Dr. Yeh has published more than 200 peer-reviewed publications and abstracts, many of which have been presented at premier ophthalmology conferences and meetings around the world. Dedicated to improving access to and the delivery of care, Dr. Yeh has partnered with colleagues, trainees, and industry to inform the development of diagnostic procedures, drug treatment, and surgical innovations in ophthalmology Dr. Yeh is a member of several professional societies and committees — including the American Academy of Ophthalmology Ophthalmic Technology Assessment Committee and the American Uveitis Society Executive Committee. He has received awards through the American Society of Retina Specialists, Macula Society and the Association for Research in Vision and Ophthalmology.