Sclera

Conditions and Disorders

Why isn't the sclera of my eye white?

Several things can cause the entire sclera to change color or spots of color to appear:

• Blue sclera: If the sclera is thinner than normal, blood vessels may show through, giving your eyeballs a blue or gray hue. This may occur in people with certain health conditions. Examples include osteogenesis imperfecta (a genetic bone disease) and Marfan syndrome (a disorder in connective tissue throughout the body). Other examples include iron deficiency and anemia.
• Icteric sclera and jaundice: If the entire sclerae turn yellow, that could mean you have jaundice. Jaundice indicates liver disease, which means the liver isn’t filtering blood properly.
• Injury: If your eyeball is injured, it may have a bright red spot. This indicates a broken blood vessel that has leaked some blood. These red spots are usually harmless and go away in a few days or weeks.
• Irritation: If your eyes are “bloodshot,” you can see redness throughout the sclerae. Eyes may be irritated due to smoke, allergies, exhaustion or infection.
• Medication: Some medications can tint the sclerae blue or gray (for example, an antibiotic called minocycline).
• Melanosis: Your sclera may contain a flat, brown spot, almost like a freckle. This is more common in Black people. The spots are caused by high levels of pigment called melanin, and they’re harmless.
• Pinguecula: A small patch of yellow may bulge out from your sclera after damage from the sun, wind or dust. The patch may become inflamed and turn pink or red.
• Pterygium: If a pinguecula goes untreated, it can get larger, expand into the cornea and block vision.
• Primary acquired melanosis (PAM): If you have a flat brown spot on the eye that changes over time, this may indicate PAM. This condition can become cancerous, so report any new or changing spots on the sclera.

What other conditions and disorders affect the sclera?

Other problems with the sclera include:

• Ectasia: When your eyeball experiences trauma (injury) or inflammation, the sclera may thin or bulge. This may heal on its own, or you may need special contact lenses.
• Episcleritis: This is inflammation (swelling) of the episclera. Your eyes may be swollen, tender and red. The condition may be associated with an inflammatory condition, such as rheumatoid arthritis. Episcleritis usually goes away on its own in a few weeks, but it can come back.
• Scleral coloboma: Sometimes, a piece of tissue is missing in the sclera from birth. It can cause a notch or a bulge in your eyeball. Treatment varies depending on how problematic the condition is. It usually involves helping people protect their eyes and making the most of the vision they have.
• Scleritis: This condition is similar to episcleritis but is more serious and often more painful. Scleritis often involves piercing pain in your eye that gets worse with eye movement. It can cause permanent damage and vision loss. Treatment options include nonsteroidal anti-inflammatory drugs (NSAIDs) and corticosteroids. It may be caused by an underlying inflammatory disease, fungus or injury.
• Senile scleral plaques: With age, the sclera can develop calcium deposits. These plaques may appear as gray spots at the 3 and 9 o’clock portions of your sclera. Only rarely can they erode through the conjunctival surface and cause irritation or infection.

How long does it take for the sclera to heal?

Minor injury or inflammation of the sclera often heals in a few days or weeks. But if you have any other symptoms or the problem doesn’t go away, talk to your healthcare provider or ophthalmologist. An ophthalmologist specializes in disorders and diseases of the eyes.