Liver Health

Add us on Google

Yellow Eyes: Why the Whites of Your Eyes Look Yellow and Which Blood Test Finds the Cause

Yellow eyes usually mean jaundice, a buildup of bilirubin. It can come from red blood cells breaking down, from the liver, or from a blocked bile duct, and slightly yellow eyes in healthy people are often Gilbert's syndrome. Learn how direct and indirect bilirubin, liver enzymes and a blood count point to the cause, and when to get prompt care.

Published

November 4, 2026

Read time

13 min read

Medically reviewed by

Rhonda Collins, FNP-C

Share

Copy link

Summarize with AI

Yellow eyes usually mean jaundice: a buildup of bilirubin, the yellow pigment made when old red blood cells are broken down. It is not always the liver. Bilirubin can rise because red blood cells are breaking down faster than normal, because the liver is not processing it, or because bile cannot drain out of the liver ^[1][2]. A harmless inherited condition called Gilbert’s syndrome is a common reason for slightly yellow eyes in otherwise healthy people ^[3].

A blood test tells these apart. Bilirubin split into its direct and indirect parts shows where the problem sits, liver enzymes (ALT, AST, ALP and GGT) show what kind of liver or bile duct problem it is, and a complete blood count with a reticulocyte count shows whether red blood cells are breaking down ^[4][5]. A whitish-yellow bump on one part of the eye, or yellow skin with white eyes, is usually something other than jaundice ^[6][1].

Normal eye color vs yellow eyes

The white of the eye, the sclera, should look white all over. In jaundice, the whole white of both eyes turns yellow, and the skin and the inside of the mouth often follow ^[1]. In more severe jaundice, these areas can look brown ^[1].

The sclera is often the first place jaundice shows. It is rich in elastin, a tissue that binds bilirubin readily, so the eyes can look yellow before the skin does ^[7].

Not every yellow tint is jaundice:

• A yellow spot or bump on one side of the white of the eye is usually a pinguecula. It is a yellowish, raised growth on the clear tissue covering the white of the eye, most often on the side near the nose, and it is linked to sun, wind and dust exposure ^[6]. It is common and benign, and it does not involve bilirubin ^[8].
• A slightly darker or yellower white with age. In a study of adult women, older faces had sclera that were darker, redder and yellower than younger faces ^[9]. That is a gradual, even change, not a new yellowing over days or weeks.
• Yellow or orange skin with white eyes points away from jaundice. Eating a lot of beta carotene can turn the skin yellow to orange, but the whites of the eyes stay white ^[1][7]. See carotenemia below.

Jaundice and bilirubin

Jaundice is a yellow color of the skin, mucous membranes or eyes caused by too much bilirubin in the blood ^[1]. Bilirubin comes from old red blood cells. The liver and spleen remove them each day, which creates bilirubin, and the liver then processes it so it can leave the body in the stool ^[1].

Bilirubin comes in two forms on a blood test ^[4][10]:

• Indirect (unconjugated) bilirubin is the form made when red blood cells break down, before the liver has processed it.
• Direct (conjugated) bilirubin is the form the liver has already processed so it can be passed into bile.

A normal total bilirubin is 0.1 to 1.2 mg/dL, and a normal direct bilirubin is less than 0.3 mg/dL, although ranges vary slightly between labs ^[10]. MedlinePlus says a level of 2.0 mg/dL can create jaundice ^[10]. A clinical review notes that yellow sclera are best seen once bilirubin is above about 3 mg/dL ^[7]. That is why a mildly raised bilirubin on a blood test often causes no visible yellowing at all.

For a side-by-side explanation of the two forms, see direct vs indirect bilirubin and the reference page for total bilirubin.

Causes of yellow eyes, by where the problem is

Jaundice happens in one of three ways: too many red blood cells are breaking down and sending bilirubin to the liver, the liver is overloaded or damaged, or bilirubin from the liver cannot move normally into the digestive tract ^[1][2]. These are often grouped as causes before the liver, in the liver and after the liver.

Raised indirect bilirubin: red cell breakdown and Gilbert’s syndrome

When red blood cells are destroyed faster than normal (hemolysis), the extra bilirubin can outpace the liver, and indirect bilirubin rises ^[4]. Normally, red blood cells last about 120 days. In hemolytic anemia they are destroyed earlier ^[11]. Causes include an immune reaction against the body’s own red blood cells, inherited problems with hemoglobin or the red cell’s structure, infections, and certain chemicals, medicines and toxins ^[11].

Gilbert’s syndrome is the other common cause of a raised indirect bilirubin. It is an inherited condition in which the liver processes bilirubin more slowly than usual ^[12]. It is estimated to affect 3 to 7 percent of Americans ^[12]. The total bilirubin is mildly raised, most often below 2 mg/dL, most of it is indirect bilirubin, and direct bilirubin is normal ^[3]. It does not cause health problems and needs no treatment ^[3]. For its symptoms, triggers and how it is confirmed, see Gilbert’s syndrome symptoms and blood tests and high indirect bilirubin.

In the liver: hepatitis, alcohol, fatty liver and medicines

When liver cells are inflamed or damaged, they cannot process and pass on bilirubin normally, so direct bilirubin builds up ^[4][5]. The main causes in adults are ^[4][2]:

• Viral hepatitis, the most common infectious cause of jaundice, from hepatitis A, B, C, D or E ^[1][2].
• Alcohol. Long-term heavy drinking can cause fatty liver with few symptoms and often no jaundice, alcoholic hepatitis with jaundice that comes on quickly, and cirrhosis ^[4].
• Fatty liver disease linked to metabolic health. Simple fatty liver usually causes no jaundice. When it progresses to advanced disease or cirrhosis, jaundice can appear ^[4][2]. See fatty liver disease symptoms and blood tests.
• Medicines and toxins. An acetaminophen overdose, reactions to other medicines, and poisons such as poisonous mushrooms can injure the liver and cause jaundice ^[2].
• Less common causes, including autoimmune hepatitis, Wilson disease and hemochromatosis ^[4].

Cirrhosis can cause yellow eyes late in its course, when liver function is already reduced ^[13].

After the liver: gallstones, bile ducts and the pancreas

When bile cannot drain from the liver into the intestine, direct bilirubin backs up into the blood ^[4][14]. A gallstone that leaves the gallbladder and blocks the bile duct is the most common reason ^[1][4]. Most gallstones never cause symptoms, and gallstones that do not block a bile duct do not cause jaundice ^[15].

Other causes include a narrowing (stricture) of the bile duct, inflammation of the bile ducts, chronic pancreatitis, and, less often, a tumor of the pancreas, bile ducts or gallbladder pressing on the duct ^[4][2]. These blockages tend to come with other clues: dark urine, pale stools, itching and pain in the upper belly ^[4]. For how the same blockage shows up in urine, see dark urine and bilirubin in urine.

Which blood tests find the cause of yellow eyes

The blood tests that sort out yellow eyes are a bilirubin test split into direct and indirect parts, a liver panel, and a complete blood count ^[4]. A family medicine review recommends starting with fractionated bilirubin, a complete blood count, ALT, AST, alkaline phosphatase (ALP), GGT, a clotting test (prothrombin time or INR), albumin and total protein ^[4].

At Mito, the hepatic function panel covers the core liver chemistries in one draw, including ALT, AST, ALP, total and direct bilirubin, and albumin. The fractionated bilirubin test reports total, direct and indirect bilirubin together. GGT is a separate GGT test, and the CBC with differential and reticulocyte count cover the red blood cell side.

Blood tests point to the likely cause, but they do not always finish the job. Depending on the pattern, the next step can be a hepatitis virus panel, an abdominal ultrasound to look for a blocked duct, or other imaging ^[1][4].

Reading the patterns

The pattern across the tests narrows the cause more than any single number ^[17][5]. Liver test results are read together, looking for patterns that suggest different types of conditions ^[17].

Bilirubin: indirect alone vs direct

• Indirect bilirubin raised, direct bilirubin normal, liver enzymes normal. This pattern can reflect excess bilirubin production or slower processing by the liver. The two main explanations are red blood cells breaking down too fast and Gilbert’s syndrome ^[4][3]. See high indirect bilirubin.
• Direct bilirubin raised. A raised direct bilirubin implies liver disease or a blocked bile duct in most settings ^[5]. The liver enzymes then show which. See high direct bilirubin and high total bilirubin.

A total bilirubin on its own cannot tell these apart. The American College of Gastroenterology recommends splitting a raised total bilirubin into its direct and indirect fractions ^[5].

Liver enzymes: ALT and AST vs ALP and GGT

• ALT and AST raised far more than ALP is called a hepatocellular pattern: the liver cells themselves are injured, as in viral hepatitis, alcohol-related liver disease or a medicine reaction ^[5].
• ALP raised far more than ALT and AST is called a cholestatic pattern: bile is not flowing normally, from inside the liver or from a blocked duct ^[5][14]. A raised GGT alongside it supports a liver or bile duct source rather than bone ^[16].

Normal enzymes do not rule everything out. ALT and AST can be normal in cirrhosis, when too little healthy liver tissue is left to release them ^[4], and normal liver chemistries do not exclude fatty liver disease or scarring ^[16]. For what each enzyme measures, see liver enzymes: ALT, AST, ALP and GGT.

CBC and reticulocytes: red cell breakdown

A raised indirect bilirubin with anemia on the CBC and a high reticulocyte count fits red blood cells being destroyed early, as in hemolytic anemia ^[11][18]. A normal CBC and reticulocyte count with a mildly raised indirect bilirubin and normal liver enzymes fits Gilbert’s syndrome instead ^[4][3].

Slightly yellow eyes in adults and teens

Slightly yellow eyes in a teenager or adult who otherwise feels well are most often Gilbert’s syndrome, and the blood test pattern above confirms it ^[3][12]. Gilbert’s syndrome is usually recognized in adolescence ^[12]. Its yellowing is mild and comes and goes, appearing most often with exertion, stress, dehydration, menstruation, infection such as a cold, or going without food ^[3][12]. About 30 percent of people with it have no symptoms and find out only from a routine blood test ^[12].

Two other common explanations involve no bilirubin at all: a pinguecula, which is a yellowish bump rather than an even tint, and the gradual darkening and yellowing of the sclera with age ^[6][9].

Slight yellowing should not be assumed to be harmless without a test. Jaundice can develop slowly over time ^[1], and MedlinePlus advises contacting a provider if you develop jaundice ^[1]. A liver panel with bilirubin is a simple way to tell a benign pattern from one that needs follow-up.

Carotenemia: yellow skin but white eyes

Carotenemia is a yellow-orange skin color caused by high levels of carotene in the blood, usually from eating a lot of carotene-rich fruits and vegetables such as carrots ^[19][1]. It is benign ^[19].

The key difference from jaundice is the eyes. In carotenemia the whites of the eyes stay white ^[1][7]. The color is most noticeable on the palms, the soles and the folds beside the nose ^[19]. If your eyes are yellow, carotene is not the explanation, and a bilirubin test is the next step.

Can dehydration cause yellow eyes?

Dehydration is not listed among the causes of jaundice by MedlinePlus ^[2]. Its role is as a trigger in Gilbert’s syndrome: in people who have it, dehydration and fasting can push bilirubin up enough to make the eyes look slightly yellow for a while ^[3][12].

So yellow eyes that appear after a day of little food and fluid, and fade within days, fit Gilbert’s syndrome. Drinking more water will not clear yellow eyes caused by a liver, bile duct or blood problem.

How to get rid of yellow eyes

Getting rid of yellow eyes means treating the cause, because the yellow color is a sign rather than a condition on its own ^[1]. Eye drops, diets and supplements do not remove bilirubin from the sclera.

• Gilbert’s syndrome needs no treatment, and the yellowing fades as each trigger passes ^[3].
• Hepatitis, alcohol-related liver disease and medicine reactions are treated by addressing the specific cause, and liver tests are used to check how well treatment is working ^[17].
• A blocked bile duct needs the blockage relieved, for example with a stent placed during an endoscopic procedure called ERCP ^[4].
• A pinguecula often needs no treatment. Lubricating eye drops can ease irritation ^[6].

The yellow color fades as bilirubin falls, which is why retesting bilirubin is how recovery is tracked.

When to get prompt care for yellow eyes

See a doctor right away if yellow eyes come with pain in the belly lasting several hours, nausea and vomiting, fever or chills, or tea-colored urine and light-colored stools ^[15]. These can be signs of a serious infection or inflammation of the gallbladder, liver or pancreas ^[15].

Also get prompt care for yellow eyes with any of these:

• Confusion, difficulty thinking, personality changes or sleep problems, which can be a sign of advanced liver disease ^[13][4].
• Yellowing that appears suddenly or deepens over days, since acute jaundice is often a sign of significant underlying disease ^[4].
• Easy bruising or bleeding, or swelling of the belly or legs ^[13].
• Unexplained weight loss or ongoing itching ^[4][1].

Yellow eyes without these signs are still a reason to contact your doctor and get a blood test ^[1].

References

1. MedlinePlus. Jaundice. National Library of Medicine. Reviewed April 21, 2025.
2. MedlinePlus. Jaundice causes. National Library of Medicine. Reviewed July 22, 2025.
3. MedlinePlus. Gilbert syndrome. National Library of Medicine. Reviewed April 21, 2025.
4. Fargo MV, Grogan SP, Saguil A. Evaluation of jaundice in adults. Am Fam Physician. 2017;95(3):164-168.
5. Kwo PY, Cohen SM, Lim JK. ACG clinical guideline: evaluation of abnormal liver chemistries. Am J Gastroenterol. 2017;112(1):18-35. PMID: 27995906
6. American Academy of Ophthalmology. What is a pinguecula and a pterygium (surfer’s eye)? Published January 13, 2026.
7. Joseph A, Samant H. Hyperbilirubinemia. In: StatPearls. StatPearls Publishing; 2023. PMID: 31334972
8. Somnath A, Tripathy K. Pinguecula. In: StatPearls. StatPearls Publishing; 2023. PMID: 32644391
9. Russell R, Sweda JR, Porcheron A, Mauger E. Sclera color changes with age and is a cue for perceiving age, health, and beauty. Psychol Aging. 2014;29(3):626-635. PMID: 25244481
10. MedlinePlus. Bilirubin blood test. National Library of Medicine. Reviewed February 13, 2025.
11. MedlinePlus. Hemolytic anemia. National Library of Medicine. Reviewed January 29, 2026.
12. MedlinePlus Genetics. Gilbert syndrome. National Library of Medicine.
13. National Institute of Diabetes and Digestive and Kidney Diseases. Symptoms & causes of cirrhosis. Reviewed June 2023.
14. Grant LM, John S. Cholestatic jaundice. In: StatPearls. StatPearls Publishing; 2025. PMID: 29489239
15. National Institute of Diabetes and Digestive and Kidney Diseases. Symptoms & causes of gallstones. Reviewed November 2017.
16. Jogu P, Zubair M, Minter DA. Liver function tests. In: StatPearls. StatPearls Publishing; 2026. PMID: 29494096
17. MedlinePlus. Liver function tests. National Library of Medicine. Last updated December 5, 2023.
18. MedlinePlus. Reticulocyte count. National Library of Medicine. Last updated April 10, 2024.
19. Al Nasser Y, Jamal Z, Albugeaey M. Carotenemia. In: StatPearls. StatPearls Publishing; 2023. PMID: 30521299

Frequently asked questions

Why are my eyes a little bit yellow?

A slight, even yellow tint to both eyes in someone who feels well is most often Gilbert's syndrome, a common, harmless inherited condition in which the liver processes bilirubin a little slowly. It tends to show up with fasting, dehydration, illness, stress or hard exercise and fades afterward. A yellowish bump on one side of the eye is usually a pinguecula, and the whites of the eyes also darken and yellow slightly with age. Because jaundice from the liver or a blood problem can also start slowly, a bilirubin and liver panel blood test is the way to know which it is.

Do yellow eyes mean dehydration?

Not on their own. MedlinePlus does not list dehydration among the causes of jaundice. Dehydration matters mainly for people with Gilbert's syndrome, where dehydration and going without food can push bilirubin up enough to make the eyes look slightly yellow for a while. Drinking more fluid will not clear yellow eyes caused by a liver, bile duct or red blood cell problem, so yellow eyes that do not fade need a blood test.

How can I clear my yellow eyes?

By treating whatever is raising bilirubin. Yellow eyes are a sign, not a condition on their own, so eye drops, diets and supplements do not remove the color. Gilbert's syndrome needs no treatment and the yellowing fades as each trigger passes. Hepatitis, alcohol-related liver disease, medicine reactions and blocked bile ducts each have their own treatment. A bilirubin test split into direct and indirect parts, with liver enzymes and a blood count, shows which cause applies.

What medicine causes yellow eyes?

Medicines can cause yellow eyes in a few ways. An acetaminophen overdose and reactions to other medicines can injure the liver. Some medicines can trigger the immune system to destroy red blood cells, which raises bilirubin. In people with Gilbert's syndrome, medicines that block the liver enzyme that processes bilirubin, such as some HIV protease inhibitors, can bring on yellowing. Do not stop a prescribed medicine on your own. Tell your prescriber about the yellowing and get a liver panel.