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Descoloração Escleral: Significado Clínico de Alterações Amarelas, Pálidas, Vermelhas e Azuis

The sclera (white of eye) reflects systemic and ocular pathology:

Yellow (Icterus / Jaundice)

Bilirubin deposition. Causes: hemolysis (pre-hepatic), hepatocellular (hepatitis, cirrhosis), obstructive (gallstones, pancreatic cancer). Urgent LFTs, imaging.

Pale / Grayish

Anemia (↓ hemoglobin → reduced vascular visibility). Check CBC, iron studies, B₁₂/folate.

Red (Injection)

• Conjunctival injection: dilated superficial vessels (allergic, viral, dry eye).
• Ciliary injection: deep perilimbal vessels (uveitis, keratitis, acute glaucoma — emergency).
• Subconjunctival hemorrhage: focal bright red; benign, resolves 1–2 wk.

Blue / Gray

Thin sclera (osteogenesis imperfecta, Ehlers-Danlos, Marfan) → choroidal show-through. Also: minocycline deposition, iron overload.

Brown / Pigmented

Racial melanosis (benign, dark skin), primary acquired melanosis (PAM — precancerous), conjunctival melanoma.

Action

Any new, asymmetric, or symptomatic scleral change warrants ophthalmologic evaluation. Self-diagnosis by color alone is unreliable.