Blue Sclera

What is a blue sclera?

“Blue sclera” is the term healthcare providers use when the white part of your eye (your sclera) turns blue or has a blue tint. The blue might look gray or even purplish.

A blue sclera can be a sign of many conditions. In young children, the cause may be an inherited genetic condition, most often a condition that affects the connective tissue in your body.

In adults, iron deficiency may cause your sclera to look blue.

You generally won’t have pain or other symptoms with a blue sclera. (You may see the plural version of this term: blue sclerae.)

Researchers think the thinning of your sclera’s fibers lets your uvea and blood vessels underneath show through, causing the blue tint.

Are there stages or different severity levels?

The difference in severity relates to the difference in causes. In most cases, having a blue sclera isn’t serious. In some cases, having a blue sclera can mean you have a more significant underlying medical condition that will need treatment. This is why your provider may order tests like a thorough eye exam, blood tests and genetic testing.

What are the most common causes of blue sclera?

Causes of blue sclera include genetic conditions, such as:

• Osteogenesis imperfecta (OI, brittle bone disease).
• Marfan syndrome, a connective tissue disease.
• Ehlers-Danlos syndrome, a connective tissue condition.
• Blue sclera syndrome (Lobstein-Van der Hoeve syndrome), an advanced version of OI.
• Incontentia pigmenti, a genetic disorder that affects many body systems, including your eyes.
• Brittle cornea syndrome, a tissue disorder that makes your cornea thin.

Other potential causes of a blue tint in your sclera include:

• Iron deficiency and iron-deficiency anemia. A lack of iron may cause a low red blood cell count.
• Rheumatoid arthritis, an autoimmune condition that affects your joints.
• Myasthenia gravis, a condition that can involve weak muscles.
• Some types of medications, including steroids, amiodarone and minocycline.
• Excessive exposure to silver.
• Nevus of Ota, or ocular dermal melanosis, which refers to hyperpigmentation (excessive color) of tissues.
• A complication of laser surgery for glaucoma.

How is blue sclera treated?

Healthcare providers will determine why your sclera is blue before deciding on specific treatments. Knowing why your sclera is blue is the only way providers know how to treat it.

A blue sclera may be a symptom of an underlying condition. For example, people with inherited conditions such as Marfan syndrome or osteogenesis imperfecta may develop a blue sclera. In those cases, providers will emphasize treatment for the underlying condition. Those treatments may help with blue sclera.

Treatments will vary depending on the disorder causing the blue sclera.

What are the possible complications or risks of not treating a blue sclera?

Typically, most cases of blue sclera don’t need treatment.

However, if you have a more serious condition, you’ll need treatment for that. Those risks or complications vary with the condition you have.

Can blue sclera be prevented?

That depends. Some people have an increased risk for blue sclera because they don’t get enough iron from the foods they eat. In that case, they could prevent blue sclera by eating iron-rich foods or taking iron supplements.

You may have an increased risk for blue sclera because you or someone in your family has certain inherited conditions. You may want to ask your healthcare provider about genetic counseling. You may not be able to prevent blue sclera but counseling may help to understand your risk as it relates to a genetic condition.

When should blue sclera be treated by a healthcare provider?

If you suddenly see a change in your eyes, contact an eye care provider. If you have this change along with other symptoms, call a provider.

Get immediate help if you have:

• A sudden change in vision.
• Blurred vision.
• Discharge from your eye.
• Sensitivity to light.
• Eye pain.

A note from Cleveland Clinic

In most cases, seeing that the white of your eye has a bluish tint isn’t a serious symptom. If your infant has blue sclera, their provider may decide to do some genetic tests. If blue sclera happens in an adult, a healthcare provider may want to test for low iron levels. In any case, your healthcare team is on your side when it comes to determining the cause of blue sclera. It’s important to keep up with eye exams to make sure your provider can detect and treat any condition.