![]() It actually makes sense that we can identify jaundice by examination of the eye: as the overlying conjunctiva becomes jaundiced, the underling sclera appears yellow (but only appears so). More specifically, the bulbar conjunctiva that covers the sclera. The letter goes on to note that that bilirubin appears in the conjunctiva. ![]() They write, “We found that of all ocular tissues, the least amount of bilirubin staining is seen in the scleral stroma.” In one of their cases, the serum bilirubin reached 60 mg/dL and yet there was no bilirubin in the sclera. The two authors note that they had studied histological sections of globes from many patients with jaundice. It is titled “Conjunctival icterus, not scleral icterus.” The letter – written by two ophthalmologists – could not be any more to the point. One is a letter published in the Journal of the American Medical Association in December 1979. There are a few pieces of evidence in support of this. One of the most fascinating parts of the answer is worth noting early: the sclera do not become jaundiced instead it is the overlying conjunctiva. ![]() Unlike with Kayser-Fleischer rings – a difficult to see finding in a rare disease – icterus is absolutely something that most students who have been on a surgical or medical ward for even a few weeks have seen. For this episode, we discussed something else that deposits in or around the eye: bilirubin. In the first episode we talked about the connection between Wilson disease and copper deposition – the Kayser-Fleischer ring. This was the second episode in a two-part series called “The Eyes Have It”.
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