By Rudrani Banik, M.D.

The white part of the eye that serves as a protective layer is called the sclera, which covers more than 80 percent of the eyeball’s surface. A healthy sclera should be white. If it becomes yellow or discolored, an underlying condition may be present. Here are some reasons why the sclera might turn color.

Yellow

If a small patch of yellow tissue bulges out of the conjunctiva, this could be a pinguecula, which is caused by UV damage from the sun, along with wind or dust damage. These patches sometimes become inflamed and appear red.

If a pinguecula is left untreated, it can turn into pterygium, which is also known as the “surfer’s eye.” Pterygium is a larger growth that can extend to the cornea, eventually blocking vision.

If the entire sclera becomes yellow, jaundice may be the problem. Jaundice occurs due to a buildup of old red blood cells called bilirubin, which is filtered out by the liver and turned into bile. Typically, bile is stored in the gallbladder and excreted by the body. Jaundice occurs when the liver, pancreas, or gallbladder isn’t functioning properly. 

A sclera that’s turning yellow warrants a visit to a healthcare provider.

Brown

Due to high levels of a dark brown pigment called melanin, African Americans may have brownish spots on the sclera, which are harmless. Brown spots can also be a nevus or a freckle on the eye.

But sometimes brown spots can raise some concerns. Primary acquired melanosis (PAM) is a precancerous condition that begins with a painless flat brown spot on the eye, similar to a freckle, that slowly changes over time. PAM usually develops in middle-aged people and appears in one eye. If PAM is not treated, it can become cancerous, so an ophthalmologist should examine any new brown spots that develop on the eye.

Red or Pink

Redness in the eye can be due to various injuries or conditions. It is imperative to have your ophthalmologist examine your eyes, specifically if redness comes with blurry vision, pain or discharge.

A bright red spot on the sclera is typically a sign of subconjunctival hemorrhage: a broken blood vessel has leaked between the conjunctiva and the sclera under the white of the eye. This is typically harmless and resolves on its own within one to two weeks.

Bloodshot eyes are due to the dilation of blood vessels in the conjunctiva. They typically happen when you are tired, have dry eyes or allergies, have been exposed to smoke or have irritation from contact lenses. Bloodshot eyes can also happen due to an eye infection like conjunctivitis (pink eye). Sometimes red eyes can raise more serious eye concerns, such as glaucoma or uveitis.

Blue or Gray

Long-term use of certain medications can give the sclera a blue-gray tint. Certain antibiotics, such as minocycline (used to treat rosacea and rheumatoid arthritis), can produce this effect. Minocycline can also make the skin, ears, teeth or fingernails appear blue-gray.

The sclera can also thin out and allow the choroid, the tissue beneath it, to peek through, creating a bluish discoloration. A thin sclera can develop in people born with osteogenesis imperfecta (brittle bone disease); Marfan’s syndrome (a connective tissue disorder); or anemia or iron deficiency. 

Anyone with bluish-gray discoloration of the whites of your eyes should speak with their ophthalmologist, who can refer them to a specialist if needed.

Rudrani Banik, M.D., is an integrative ophthalmologist and the founder of Envision Health NYC, located at 136 East 57th St., Ste. 1502. She’s the author of the ebook 6 Secrets to Eye Health: Enjoy Clear Vision for a Lifetime, which can be downloaded for free at her website, RudraniBanikMD.com.