What is the medical term for the yellowing of the eyes caused by ethanol (ETOH) abuse?

Scleral Icterus: The Medical Term for Yellowing of Eyes Due to Alcohol Abuse

The medical term for yellowing of the eyes caused by ethanol (alcohol) abuse is scleral icterus, which is a clinical manifestation of jaundice resulting from alcoholic liver disease (ALD). This condition occurs when bilirubin accumulates in the body due to alcohol-induced liver damage 1.

Pathophysiology of Alcohol-Induced Scleral Icterus

Alcohol abuse leads to a spectrum of liver diseases that can cause jaundice:

1. Initial liver damage: Chronic alcohol consumption causes:

   • Alcoholic fatty liver (steatosis) - the earliest stage
   • Alcoholic steatohepatitis - inflammatory stage
   • Fibrosis and cirrhosis - advanced stages 1

2. Mechanism of yellowing:

   • Alcohol is metabolized into acetaldehyde by alcohol dehydrogenase (ADH)
   • Acetaldehyde causes mitochondrial damage and oxidative stress
   • This impairs the liver's ability to process bilirubin
   • Excess bilirubin deposits in tissues, including the sclera (white part of the eye), causing yellowing 1

3. Progression:

   • The yellowing of eyes typically appears when serum bilirubin levels exceed 2-3 mg/dL
   • It often accompanies other signs of alcoholic liver disease, including jaundice of the skin 1

Risk Factors for Developing Alcohol-Induced Scleral Icterus

The risk increases with:

• Quantity of alcohol: Consumption exceeding 40g/day in men and 20g/day in women significantly increases risk 1
• Duration of alcohol abuse: Years of chronic consumption
• Pattern of drinking: Both daily drinking and binge drinking increase risk 1
• Co-existing factors: Obesity, smoking, and viral hepatitis worsen outcomes 1

Diagnostic Approach

When evaluating scleral icterus in suspected alcohol abuse:

1. Alcohol use assessment:

   • Standardized questionnaires (AUDIT, CAGE)
   • Biomarkers of alcohol use:
     • Phosphatidylethanol (PEth) - detects alcohol use for up to 4 weeks 1
     • Ethyl glucuronide (EtG) - detectable for up to 3 days 1
     • Gamma-glutamyltransferase (GGT) and other liver enzymes 1

2. Liver function tests:

   • Total and direct bilirubin levels
   • AST, ALT, alkaline phosphatase
   • Albumin and prothrombin time

3. Rule out other causes:

   • Viral hepatitis
   • Biliary obstruction
   • Hemolytic disorders

Management Implications

The presence of scleral icterus in alcohol users indicates significant liver dysfunction requiring:

1. Immediate alcohol abstinence - essential for survival and potential recovery 1

2. Assessment of disease severity:

   • Maddrey's Discriminant Function
   • MELD score
   • Glasgow Alcoholic Hepatitis Score

3. Treatment considerations:

   • Nutritional support
   • For severe alcoholic hepatitis: prednisolone, possibly with N-acetylcysteine 2
   • Management of complications (ascites, encephalopathy)

Clinical Pitfalls and Caveats

• Don't miss concomitant conditions: Patients with alcoholic liver disease often have concurrent viral hepatitis that requires separate management 1

• Beware of other alcohol-related eye manifestations: Beyond scleral icterus, alcohol can cause:

  • Nutritional optic neuropathy
  • Impaired color vision, particularly blue-yellow discrimination 3, 4

• Monitor for severe disease: Scleral icterus with other signs of liver failure may indicate severe alcoholic hepatitis, which carries 40-60% six-month mortality without treatment 5

• Recognize the need for long-term monitoring: Even with abstinence, advanced liver disease may progress, requiring ongoing surveillance

Remember that scleral icterus represents significant liver dysfunction, not just a cosmetic issue, and warrants thorough evaluation and aggressive management of the underlying alcoholic liver disease.