From the Research
The best location to inspect for signs of jaundice in a dark-skinned individual is the sclera of the opened eye. When assessing for jaundice, which is caused by elevated bilirubin levels in the blood, the sclera is typically the first area to show yellowing, even in patients with darker skin tones. This is because the sclera has a high elastin content and a strong affinity for bilirubin deposition. Additionally, the sclera lacks melanin, which means the yellow discoloration of jaundice is not masked by skin pigmentation, making it more readily visible regardless of the patient's skin color 1. Other areas that may show jaundice include the palms, soles, and oral mucosa, but these are generally less reliable and may show changes later than the sclera, especially in individuals with darker skin.
The nurse practitioner should ensure adequate lighting when examining the sclera and gently pull down the lower eyelid while asking the patient to look upward to fully visualize the area. This approach is supported by the most recent and highest quality study, which highlights the importance of inspecting the sclera for signs of jaundice, particularly in dark-skinned individuals 1. The use of digital photography to quantify the yellowness of the sclera, as described in the study, can also be a useful tool in assessing jaundice in these patients.
Some key points to consider when inspecting for jaundice in dark-skinned individuals include:
- The sclera is the most reliable area to inspect for jaundice, due to its lack of melanin and high affinity for bilirubin deposition
- Other areas, such as the palms, soles, and oral mucosa, may also show signs of jaundice, but are less reliable
- Adequate lighting is essential when examining the sclera for jaundice
- Gentle pulling down of the lower eyelid and asking the patient to look upward can help to fully visualize the sclera. It is worth noting that while other studies discuss the diagnosis and evaluation of hyperbilirubinemia, they do not provide specific guidance on the best location to inspect for signs of jaundice in dark-skinned individuals 2, 3, 4, 5. Therefore, the recommendation to inspect the sclera of the opened eye is based on the most relevant and highest quality study available 1.