What is the description of scleral icterus (jaundice)?

From the Guidelines

Jaundice sclera should be described by noting the yellow discoloration of the white part of the eyes, including its intensity, distribution, and any accompanying symptoms, as it is a critical indicator of hyperbilirubinemia. When documenting jaundice, it is essential to specify whether the yellowing is mild, moderate, or severe, and whether it affects the entire sclera or only portions, as this information can help guide further diagnosis and treatment 1. The timing of onset and progression is also crucial to document, as is any associated symptoms like abdominal pain, fever, or pruritus. Jaundice in the sclera occurs when bilirubin levels in the blood exceed 2-3 mg/dL, causing this pigment to deposit in tissues, and the sclera is particularly sensitive for detecting jaundice due to its high elastin content, which has a strong affinity for bilirubin 1. Some key points to consider when describing jaundice sclera include:

• The intensity of the yellow discoloration
• The distribution of the yellowing, including whether it affects the entire sclera or only portions
• Any accompanying symptoms, such as abdominal pain, fever, or pruritus
• The timing of onset and progression of the jaundice
• Any associated signs, such as yellow skin, dark urine, or pale stools. The sclera is a reliable physical sign of hyperbilirubinemia, appearing before skin manifestations and helping distinguish true jaundice from other causes of yellow skin discoloration, as noted in the study published in the Journal of the American College of Radiology 1.

From the Research

Description of Jaundice Sclera

• Jaundice is a clinical manifestation of disorders of underlying bilirubin metabolism, hepatocellular dysfunction, or biliary obstruction 2
• The yellowing of the eyes or skin can be somewhat nonspecific for the underlying etiology of the disease 2
• Clinical signs of jaundice occur when the serum bilirubin level exceeds 2.5 to 3 mg/dL 2
• Jaundice can be described as a yellow discoloration of the sclera, which can be used as a screening technique for neonatal jaundice 3
• The sclera color of the eye can be used to predict the total serum bilirubin (TSB) levels, with a linear correlation coefficient of 0.75 and a rank correlation coefficient of 0.72 3

Key Characteristics

• The yellow discoloration in the sclera is a key characteristic of jaundice 3
• The severity of the yellow discoloration can be correlated with the level of serum bilirubin 3
• The sclera color can be used as a non-invasive screening technique for jaundice 3

Diagnostic Approaches

• A stepwise approach to evaluation is necessary for accurate diagnosis and effective treatment plan 2
• Laboratory findings, such as elevated alkaline phosphatase and gamma-GT, can indicate the presence of cholestasis 4
• Imaging modalities, such as ultrasonography, can be used to evaluate the upper abdomen and suspect extrahepatic obstruction 4