University of Iowa Health Care

Ophthalmology and Visual Sciences


Contributor: Zachary Q. Mortensen, MD

Photographer: Zachary Q. Mortensen, MD


  • External Eye Disease

Posted March 3, 2020

The image shows conjunctival icterus in a 49-year-old Hispanic female with decompensated alcoholic cirrhosis with severe alcoholic hepatitis. Bilirubin level is at 30 mg/dL (normal limit <=1.2 mg/dL). In addition to the yellowed conjunctiva, note the surrounding jaundiced skin. The yellow hue is better appreciated when seen in natural light and when juxtaposed with the white paper and/or the examiner's finger.  The deposits of bilirubin are contained in the conjunctiva, and the color is accentuated by the white scleral background. Thus "scleral icterus" is technically an incorrect term.

conjunctival icterus

conjunctival icterus

conjunctival icterus

conjunctival icterus


  1. Tripathi RC and Sidrys LA. (1979). 'Conjunctival icterus,'not'scleral icterus'. JAMA242(23), 2558-2558.
  2. Manning MH, Rustgi AK, Chamberlain SH, Marcus DM. Gastrointestinal and Nutritional Disorders. In: Mannis MJ, Holland EJ (eds), Cornea, 4th edition. Elsevier. (2017) Chapter 332, 4535-4546

Contributor: William Charles Caccamise, Sr, MD, Retired Clinical Assistant Professor of Ophthalmology, University of Rochester School of Medicine and Dentistry

*Dr. Caccamise has very generously shared his images of patients taken while operating during the "eye season" in rural India as well as those from his private practice during the 1960's and 1970's. Many of his images are significant for their historical perspective and for techniques and conditions seen in settings in undeveloped areas.

Category: Systemic Disorders

Posted February 8, 2008


India is rife with hepatitis. Because of heavy skin pigmentation, jaundice of the skin may not be evident. Jaundice of the eyes frequently is the first clinical evidence of hepatitis. Bilirubin salts are deposited diffusely in the conjunctiva and episclera. The sclera is not involved unless the jaundice is severe. The photo shows icterus/jaundice.

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last updated: 3-03-2020
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