Are Yellow Eyes A Sign Of Liver Failure?

The liver is a key organ in the upper right-hand side of your abdomen. It has many important functions, including producing key proteins, energy metabolism, macronutrient metabolism, and lipid and cholesterol control. 

The liver also produces a digestive fluid called bile, which has two key roles. Firstly, bile enables the removal of waste products.

Secondly, bile breaks down fats into fatty acids, which your digestive tract can take into the body. 

Acute liver failure is a rapid decline in the function of the liver with no preexisting liver disease.

Jaundice

Jaundice refers to yellow discoloration of the skin and mucous membranes secondary to hyperbilirubinemia. The main pigment in bile is bilirubin, which is a yellowish-colored substance. An excessive build-up of bilirubin causes jaundice. 

Typically, bilirubin levels are around one milligram per deciliter (mg/dL). Generally, yellowing of the skin and eyes occurs when the bilirubin level is about 2–3 mg/dL.

In rare cases, further increases in bilirubin levels may progress jaundice from yellow to green in longer-standing conditions. This color change is due to biliverdin, another substance found in bile.

Causes and symptoms of liver diseases

Obesity

Nonalcoholic fatty liver disease is the most common obesity-related liver disease (NAFLD). 

Although scientists are unsure of the exact cause, NAFLD seems to be the liver’s display of metabolic syndrome. 

It can lead to: 

• Apoptosis (programmed cell death) of liver cells

• Necrosis (unprogrammed cell death) of liver cells

• Oxidative stress (where free radicals damage cells and contribute to aging) of the liver cells

• Inflammation of the liver

This damage can progress into end-stage liver disease. Symptoms include:

• Vague right upper abdominal discomfort

• Fatigue

• Malaise

Alcoholism

Generally, alcoholic liver disease occurs after years of persistently drinking too much or binge drinking. The liver is responsible for processing the alcohol you consume, so excess alcohol consumption can damage the liver and cause inflammation.

Alcoholic liver disease is the most prevalent chronic liver disease globally.

Generally, people remain asymptomatic until the advanced stages of the disease, when cirrhosis sets in.

When symptoms do appear, they include:

• Feeling sick

• Weight loss

• Fatigue

• Abdominal pain

Infectious hepatitis

Hepatitis refers to inflammation of the liver. Alcohol abuse, some medications, and viruses such as hepatitis A, B, C, or SARS-CoV-2 (COVID-19) can cause it. Some viruses, such as hepatitis A and SARS-CoV-2, cause acute disease; others, such as hepatitis B and C, cause chronic disease.

Symptoms can include: 

• Fatigue

• Jaundice

• Nausea

• Anorexia

Inherited conditions

The most common genetic liver conditions include: 

Hemochromatosis

This hereditary disease results in an excess iron build-up in organ tissues, leading to tissue damage.

Alpha 1 antitrypsin deficiency (AATD)

This can cause both liver and lung disease. Your liver makes a protein called AAT to protect the lungs and other parts of the body from a protein secreted by neutrophils that breaks down tissues. 

In this condition, the protein is not properly built and accumulates in the liver, causing injury to its cells. It also means the protein cannot reach its targets in the lungs or elsewhere.

Wilson’s disease

This hereditary condition results in excess copper accumulation in the brain and kidneys, but predominantly in the liver.

Yellowing of the eyes and liver problems

Yellowing of the eyes can indicate that your liver is not functioning properly. This can sometimes be a sign of acute liver dysfunction, so it’s crucial to be proactive and seek medical advice.

Can liver disease cause eye problems?

Eye complications can be due to direct toxicity of abnormal metabolites, excess of normal metabolites, or problems with metabolism. Metabolites form when your body breaks down cells, drugs, food, or chemicals. These substances include things like amino acids and pigments like bilirubin.

Liver disease can cause eye problems, so early diagnosis is vital to minimize long-term damage.

Some common eye complications include:

Xanthelasma

Deposits of cholesterol can occur around the eyes, rarely resulting in impaired vision.

Vitamin A deficiency

Vitamin A is essential for your vision and is stored in the liver. Your body depends on bile produced by the liver to absorb vitamin A. Scarring of the liver (cirrhosis) is related to vitamin A deficiency.

Color blindness

Drinking too much alcohol can cause cirrhosis, which in turn can cause color blindness, though this is rare.

Other conditions that can cause yellowing of the eyes

Pancreatitis or pancreatic cancer

The pancreas is below the liver, so inflammation of the pancreas or cancer can block the release of bile from the liver. This results in components of bile building up in the blood and depositing in the skin and the eyes. Around 70% of people with pancreatic cancer present with jaundice.¹

Pinguecula

A pinguecula is a small yellow-and-white growth in the eye. This is typically a harmless degenerative condition due to chronic exposure to UV radiation, wind, and dust.²

Malaria

Malaria spreads to humans through mosquito bites. The parasite travels to the liver, where the infection starts. As the malarial parasites damage the red blood cells, the liver produces bilirubin as it breaks the cells down. This may cause yellowing of the eyes due to a sudden increase in bilirubin levels.

Sickle cell anemia

Sickle cell anemia is an inherited disorder that affects the shape of red blood cells. Red blood cells are more fragile in people with sickle cell anemia, so the liver breaks them down more than usual, resulting in more bilirubin. This can lead to yellowing of the skin and eyes, especially during sickle cell crises.

Treatments available for liver health

First, your doctor will ask you some questions to determine the cause of your symptoms. This may involve asking about your drug and alcohol use, risk factors for hepatitis, HIV, and any family history of liver problems. They’ll also ask if you’re experiencing any other symptoms and how long you’ve had them. 

To assess if jaundice is causing your yellow eyes, your doctor can measure the bilirubin levels in your blood. They can also order liver function tests and a complete blood count (CBC).

Jaundice itself typically requires no treatment in adults, so doctors treat the cause.

For nonalcoholic fatty liver disease, doctors commonly recommend lifestyle changes. Making these changes can also reduce the risk of cardiovascular complications. 

A liver transplant may be necessary if you have chronic liver failure and your liver can no longer heal itself.

Your doctor may prescribe antiviral medication if the cause of the liver disease is viral. 

Other ways to maintain your liver health include minimizing or eliminating alcohol consumption, eating a healthy diet, and avoiding illicit drugs. Exercise and maintaining a healthy weight are important for preserving liver function and boosting overall health. 

The lowdown

If your eyes start to look yellow, make an appointment with your doctor to determine the potential cause. The sooner you address your symptoms, the better for your long-term health.

Various issues can cause yellow eyes, and liver failure can present differently. Liver complications are relatively common, and treatments are available.

Frequently asked questions

What stage of liver failure does jaundice occur in?

The most common staging system for cirrhosis is the Child-Pugh score. Jaundice generally signifies B or C-grade cirrhosis, indicating significant liver function issues and deterioration.

Why do eyes turn yellow with liver failure?

Bilirubin binds easily with the conjunctiva (the clear, thin membrane covering your eye), leading to yellow discoloration. Generally, the yellow discoloration is a sign of acute liver dysfunction or chronic liver disease.