Yellowing of the whites of the eyes (scleral icterus) is most often a sign of jaundice, which means bilirubin—the yellow pigment from bile breakdown—is accumulating in the blood. This can occur for several reasons, some urgent. Here’s a concise overview of common causes, what to watch for, and when to seek care. What it can indicate
- Liver-related issues: hepatitis (viral or alcohol-related), cirrhosis, fatty liver disease, or liver failure that impairs bilirubin processing. Signs to look for include fatigue, right upper belly pain, dark urine, pale stools, and itching.
- Bile flow problems: blockage or narrowing of the bile ducts due to gallstones, tumors, or strictures can cause bilirubin to back up.
- Red blood cell problems: increased breakdown of red blood cells (hemolysis) can raise bilirubin levels.
- Pancreatic or intestinal issues: conditions like pancreatitis or pancreatic cancer can disrupt bile production and flow.
- Medications or toxins: certain drugs can at times trigger jaundice in susceptible individuals.
- Neonatal jaundice (not typically the adult case): in newborns, immature liver function can cause temporary yellowing.
Red flags that require urgent care
- Sudden, severe yellowing with new belly pain, confusion, shortness of breath, fever, or fainting.
- Very dark urine or clay-colored stools, or a history of liver disease with new symptoms.
- Jaundice accompanied by swelling of the legs or abdomen, or significant weakness.
- If there is a known risk of hepatitis exposure (recent travel, new medications, IV drug use, or unwell contacts).
What to do next
- If you have mild yellowing without other concerning symptoms and are otherwise well, schedule a primary care visit to evaluate liver function tests (bilirubin, liver enzymes), a complete blood count, and possibly imaging if indicated.
- If you have any red-flag symptoms, seek urgent medical attention or go to an emergency department.
Precautions and guidance
- Do not ignore jaundice in adults; it rarely resolves on its own and may reflect a condition that needs treatment.
- If you’re taking new or multiple medications, mention them to your clinician, as drug-induced jaundice is a possibility.
- If you have a known liver condition, or a family history of liver disease, mention this to your clinician for appropriate monitoring.
If you’d like, provide any additional details such as age, other symptoms (stomach pain, itching, dark urine, pale stools, weight changes), recent travel or exposures, alcohol use, or medication changes. This will help tailor the guidance toward potential causes and the appropriate next steps.
