Why Are My Eyes Yellow? Causes of Yellow Eyes, Jaundice and When an Abdominal Ultrasound May Help

What Does It Mean If the Whites of My Eyes Are Yellow?

Yellowing of the whites of the eyes is known medically as scleral icterus. It usually occurs when bilirubin levels in the blood become raised.

Bilirubin is a yellow substance produced when the body breaks down old red blood cells. Normally, bilirubin is processed by the liver and removed from the body through bile, which passes into the gut and eventually leaves the body in the stool.

If this process is disrupted, bilirubin can build up in the blood and tissues, causing:

• Yellow eyes
• Yellow skin
• Dark urine
• Pale or clay-coloured stools
• Itchy skin
• Tiredness
• Nausea
• Abdominal discomfort

In some people, the yellow colour is easier to notice in the eyes than in the skin, especially in people with darker skin tones.

Is Yellow Eyes the Same as Jaundice?

In most cases, yes. When both eyes appear yellow, especially if the skin also looks yellow, this usually suggests jaundice.

However, not every yellow-looking eye is true jaundice. A local eye problem, such as healing from a small bleed under the surface of the eye, may sometimes create a yellowish patch in one area. This is different from generalised yellowing of the whites of both eyes.

Understanding Bilirubin: Why the Body Turns Yellow

To understand jaundice, it helps to understand bilirubin metabolism. Red blood cells carry oxygen around the body. After around 120 days, old red blood cells are broken down, mainly in the spleen. During this process, haemoglobin is broken down and bilirubin is produced.

Bilirubin then travels to the liver, where it is processed and made water-soluble. This processed bilirubin is passed into bile, stored or concentrated through the gallbladder system, and drained into the small bowel through the bile ducts.

The body removes bilirubin mainly through stool, which is one reason normal stool has a brown colour. If bilirubin cannot be processed or drained properly, it accumulates in the bloodstream and causes yellow eyes and skin.

The Three Main Types of Jaundice

Common Causes of Yellow Eyes

Gallstones

Gallstones are one of the most common causes of obstructive jaundice. Gallstones form when bile components harden inside the gallbladder. Many people have gallstones without symptoms. However, if a stone moves and blocks the bile duct, bile cannot drain normally.

• Yellow eyes
• Right upper abdominal pain
• Pain after fatty meals
• Nausea or vomiting
• Dark urine
• Pale stools
• Fever if infection develops

A private gallbladder ultrasound scan can assess the gallbladder for stones, sludge, inflammation and bile duct dilatation.

Hepatitis

Hepatitis means inflammation of the liver. It may be caused by viral infections such as hepatitis A, B, C or E, alcohol, medications, autoimmune disease or fatty liver inflammation.

Symptoms may include yellow eyes, tiredness, loss of appetite, nausea, abdominal discomfort, dark urine, muscle aches and fever in some viral infections. Blood tests are essential in suspected hepatitis. Ultrasound may help assess liver size, texture, associated bile duct problems and complications.

Fatty Liver Disease

Fatty liver disease occurs when excess fat builds up within liver cells. In many people, fatty liver causes no symptoms and is found incidentally on blood tests or ultrasound. However, in some cases it can progress to inflammation, fibrosis and cirrhosis.

• Being overweight
• Type 2 diabetes
• High cholesterol
• High triglycerides
• Metabolic syndrome
• Excess alcohol intake

Ultrasound can detect fatty infiltration of the liver, while liver elastography or FibroScan can help assess stiffness and fibrosis risk.

Relevant services: private liver ultrasound scan and private liver shear wave elastography scan.

Alcohol-Related Liver Disease

Excess alcohol intake can damage liver cells and lead to fatty liver, alcohol-related hepatitis, fibrosis and cirrhosis. Jaundice may occur when liver inflammation or liver failure becomes significant.

• Swollen abdomen
• Easy bruising
• Weight loss
• Muscle wasting
• Confusion
• Vomiting blood
• Black stools

Anyone with yellow eyes and a history of heavy alcohol intake should seek urgent medical assessment.

Bile Duct Blockage

The bile ducts are small channels that carry bile from the liver and gallbladder into the bowel. If these ducts are blocked, bilirubin cannot drain properly.

Possible causes include gallstones, bile duct strictures, pancreatic inflammation, pancreatic cancer, bile duct cancer and enlarged lymph nodes.

Symptoms may include yellow eyes, dark urine, pale stools, itching, weight loss, right upper abdominal pain and fever if infection occurs. Ultrasound is often one of the first imaging tests used to look for bile duct dilatation and gallstones.

Book a private abdominal ultrasound scan in London.

Pancreatic and Bile Duct Conditions

The lower bile duct passes near the pancreas. If the pancreas becomes inflamed or enlarged, or if a mass develops near the bile duct, bile drainage may become blocked.

• Painless jaundice
• Unexplained weight loss
• New diabetes
• Persistent upper abdominal pain
• Back pain
• Pale stools
• Dark urine
• Loss of appetite

Ultrasound may assess the liver, gallbladder, bile ducts and visible parts of the pancreas, but further imaging such as CT or MRI/MRCP may be needed if the pancreas or bile ducts cannot be fully assessed.

Gilbert’s Syndrome

Gilbert’s syndrome is a common inherited condition where the liver processes bilirubin slightly less efficiently. It is usually harmless and may cause mild yellowing of the eyes that comes and goes.

Triggers may include fasting, dehydration, stress, illness, lack of sleep and strenuous exercise. People with Gilbert’s syndrome usually have normal liver enzymes apart from mildly raised bilirubin. However, it should be diagnosed properly rather than assumed.

Medication-Related Jaundice

Some medicines and supplements can affect the liver or bile flow. Examples may include certain antibiotics, anti-seizure medications, rare statin reactions, herbal supplements, bodybuilding supplements, paracetamol overdose and some cancer treatments.

Never stop prescribed medication without medical advice, but always tell your doctor about all medicines, supplements and herbal products you take.

Blood Disorders and Haemolysis

If red blood cells break down too quickly, bilirubin production increases. This may occur with haemolytic anaemia, sickle cell disease, thalassaemia, autoimmune haemolysis, certain infections and some drug reactions.

In these cases, ultrasound may not be the main test. Blood tests are usually more important, including full blood count, reticulocyte count and haemolysis markers.

What Symptoms Should You Check Alongside Yellow Eyes?

How Are Yellow Eyes Investigated?

Clinical History

This includes symptoms, alcohol intake, medication use, travel history, infection risk, family history and previous liver problems.

Physical Examination

A clinician may check for:

• Yellow skin and eyes
• Abdominal tenderness
• Enlarged liver
• Enlarged spleen
• Fluid in the abdomen
• Signs of chronic liver disease

Blood Tests

Important blood tests may include:

• Bilirubin
• ALT
• AST
• ALP
• GGT
• Albumin
• Full blood count
• Clotting profile
• Hepatitis screen
• Inflammatory markers
• Kidney function
• Pancreatic enzymes where appropriate

Book private blood tests in London.

How Can Ultrasound Help If Your Eyes Are Yellow?

Abdominal ultrasound is often one of the first imaging tests used when jaundice is suspected. It is particularly helpful when doctors suspect obstructive jaundice, such as gallstones or bile duct blockage.

Abdominal ultrasound can assess:

• Liver size and texture
• Fatty liver change
• Liver lesions or cysts
• Gallstones
• Gallbladder inflammation
• Bile duct dilatation
• Spleen enlargement
• Ascites
• Visible parts of the pancreas
• Kidney abnormalities

Book a private abdominal ultrasound scan in London.

What Ultrasound Findings May Be Seen in Jaundice?

When Is FibroScan or Liver Elastography Useful?

If liver disease, fatty liver or fibrosis is suspected, liver elastography may be recommended. Liver shear wave elastography or FibroScan measures liver stiffness. Increased stiffness may suggest fibrosis or cirrhosis.

It may be useful for patients with:

• Fatty liver disease
• Alcohol-related liver concerns
• Viral hepatitis monitoring
• Abnormal liver blood tests
• Known liver fibrosis risk
• Previous abnormal liver ultrasound

Relevant services: private liver shear wave elastography scan and liver health check package.

Yellow Eyes After Eating: Could It Be Gallbladder Related?

Some patients notice abdominal symptoms after fatty meals and later develop yellow eyes. Gallbladder-related symptoms may include right upper abdominal pain, pain spreading to the back or shoulder, nausea, bloating, indigestion-like discomfort and jaundice if a stone blocks the bile duct.

If jaundice occurs after episodes of gallbladder pain, urgent assessment is needed because a bile duct stone may require hospital-based treatment.

Yellow Eyes Without Pain: Is That More Concerning?

Painless jaundice can sometimes be more concerning than painful jaundice. Gallstones often cause pain, although not always. Painless jaundice may occur with bile duct narrowing, pancreatic disease or other causes that need prompt investigation.

You should not assume painless yellow eyes are harmless.

Can Diet Cause Yellow Eyes?

Eating large amounts of foods rich in beta-carotene, such as carrots or sweet potatoes, can sometimes cause yellow-orange skin discolouration. This is called carotenemia.

However, carotenemia usually does not turn the whites of the eyes yellow. If the whites of your eyes are yellow, jaundice should be considered until proven otherwise.

What Should You Do If You Notice Yellow Eyes?

1. Do not ignore it.
2. Check whether your urine is dark or stools are pale.
3. Note any abdominal pain, fever, weight loss or itching.
4. Avoid alcohol until assessed.
5. Review any new medications or supplements with a clinician.
6. Seek urgent medical advice.
7. Arrange blood tests and imaging if recommended.

If you feel seriously unwell, have severe pain, fever, confusion, vomiting, fainting or signs of infection, seek emergency medical care.

Frequently Asked Questions

Final Thoughts

Yellow eyes are most commonly caused by jaundice, which means bilirubin has built up in the blood. This can happen because bilirubin is being produced too quickly, the liver is not processing it properly, or bile cannot drain normally due to blockage.

Common causes include gallstones, hepatitis, fatty liver disease, alcohol-related liver injury, medication-related liver problems, Gilbert’s syndrome and bile duct obstruction.

Abdominal ultrasound plays an important role in assessing the liver, gallbladder, bile ducts and surrounding abdominal organs. It is especially useful when gallstones or obstructive jaundice are suspected. However, jaundice should usually be assessed with both blood tests and imaging, and a normal ultrasound does not exclude every serious cause.

If you notice new yellowing of the eyes, especially with dark urine, pale stools, itching, fever, abdominal pain, vomiting, weight loss or feeling unwell, seek medical advice promptly.