Yellow eyes in adults: causes of jaundice and when to worry

What causes jaundice?

Bilirubin is a yellow pigment made when old red blood cells are broken down. The liver processes it and passes it out in bile. Jaundice appears when there is too much bilirubin, when the liver cannot process it, or when bile cannot drain.

• Viral hepatitis (A, B, C or E), often after contaminated water or food for A and E
• Alcohol-related liver disease and fatty liver that has progressed
• Some medicines and supplements, including some herbal remedies
• Gallstones or, less often, a growth blocking the bile duct
• Faster breakdown of red blood cells, or Gilbert's syndrome, a harmless inherited condition

Symptoms that often come with it

Dark, tea-coloured urine, pale stools, itching, tiredness, loss of appetite, nausea and pain in the upper right side of the abdomen. Jaundice without fever is still worth checking: painless jaundice can be a sign of a blocked bile duct.

When to get urgent care

Go to an emergency department straight away if jaundice comes with any of these.

• High fever with shivering, or severe pain in the abdomen
• Confusion, unusual sleepiness or behaviour change
• Vomiting blood, or black, tarry stools
• Jaundice in pregnancy

How it is diagnosed

A gastroenterologist will ask about alcohol, medicines, travel and recent illness, and examine you. Blood tests (liver function tests, hepatitis markers and a blood count) show what kind of jaundice it is. An abdominal ultrasound looks for gallstones, a blocked bile duct or liver changes. Some people need further scans or an endoscopic test.

Treatment depends on the cause: rest and fluids for most hepatitis A and E, antiviral medicines for some hepatitis B and C, stopping the drug or alcohol responsible, or removing a stone blocking the bile duct.