Yellow Eyes in Black People: Normal Pigment or Jaundice?

Many Black people have whites of the eyes that are not bright white. Brown patches near the colored part of the eye are usually normal pigment, called complexion-associated melanosis, which is common in darker-skinned people and does not turn into cancer (Oellers and Karp, 2012). A raised yellowish bump on the side of the eye is often a pinguecula, a harmless growth linked to sun and wind (American Academy of Ophthalmology). True jaundice is different: an even yellow tint across the whites of both eyes, caused by too much bilirubin in the blood (MedlinePlus). New yellowing of the eyes in an adult needs a doctor and a blood test, soon.

The white of the eye is covered by a thin, clear layer called the conjunctiva. In people with more melanin, that layer often carries pigment too. Ophthalmologists call it complexion-associated melanosis. A review of pigmented spots on the eye describes it as frequently seen in more darkly pigmented people, notes that it can become quite large, and says it does not progress to melanoma (Oellers and Karp). It usually shows as flat brown patches, often near the edge of the colored part of the eye, in both eyes.

That is different from a single dark spot. The same review lists the other pigmented spots an eye doctor considers: a nevus (a mole on the eye, which only rarely turns cancerous), primary acquired melanosis, and melanoma (Oellers and Karp). Melanoma of the eye surface is uncommon in Black patients. In a survey of 1,643 conjunctival tumors at an ocular oncology center, African American patients made up less than 1% of the melanomas (Shields et al., 2004). Uncommon is not never, so a spot that is new, growing, raised or only in one eye still needs an exam.

A yellowish, slightly raised bump on the white of the eye, usually on the side nearest the nose, is often a pinguecula. The American Academy of Ophthalmology says it can contain protein, fat or calcium and is believed to be caused by a mix of sunlight, wind and dust (AAO). It sits in one spot. Jaundice does not.

MedlinePlus defines jaundice as a yellow color in the skin, mucous membranes or eyes that comes from bilirubin, a yellow byproduct of breaking down old red blood cells (MedlinePlus). It builds up when too many red cells break down at once, when the liver is overloaded or damaged, or when bile cannot drain into the gut. Blood tests show the raised bilirubin (MedlinePlus).

MedlinePlus lists causes including viral hepatitis, certain medicines or an acetaminophen overdose, inherited conditions such as Gilbert syndrome, chronic liver disease, gallstones blocking the bile duct, blood disorders, cancer of the pancreas and cirrhosis (MedlinePlus). Several of these are serious, which is why new jaundice in an adult is not something to watch for a few weeks.

On light skin, jaundice often shows up as yellow skin. On brown and Black skin, the skin color can hide it, so look where melanin does not get in the way. Because MedlinePlus defines jaundice as yellowing of the skin, mucous membranes or eyes (MedlinePlus), the practical checks are:

• The whites of both eyes, in daylight rather than under warm indoor light.
• The inside of your lower lip, your gums and the underside of your tongue.
• A comparison with an old photo, or with how your eyes looked a month ago.

We could not find a study that tests how well people spot jaundice on dark skin at home, so treat these as clues to bring to a doctor, not as a test. The blood test for bilirubin is what settles it. For jaundice in babies, see our guide to newborn jaundice on Black skin.

Gilbert syndrome. A mild, inherited condition that affects an estimated 3 to 7 percent of Americans. The liver handles bilirubin more slowly, so levels rise for short periods, typically during dehydration, fasting, illness, hard exercise or menstruation, and only rarely high enough to cause visible jaundice. It is usually recognized in the teen years, and about 30 percent of people with it have no symptoms at all (MedlinePlus). If your eyes turn faintly yellow when you are sick or skipping meals and clear again, ask about it.

G6PD deficiency. An inherited enzyme problem that makes red blood cells break down early, which can cause paleness, yellowing of the skin and whites of the eyes, dark urine, tiredness and a fast heartbeat. Episodes are usually triggered by infections, certain drugs such as some antibiotics and antimalarials, or fava beans. MedlinePlus says it affects about 1 in 10 African American males in the United States (MedlinePlus). See our guide to G6PD deficiency in Black adults.

Sickle cell disease. The National Heart, Lung, and Blood Institute lists a yellowish color of the skin or whites of the eyes among its symptoms, caused by many red cells breaking down at once (NHLBI). People with sickle cell disease often know their eyes yellow during a flare; new or worse yellowing still deserves a call to the care team. Our guide to sickle cell disease care in adults covers the rest.

Liver and gallbladder problems. Viral hepatitis, chronic liver disease such as advanced fatty liver disease, cirrhosis, some medicines and gallstones that block the bile duct all appear on MedlinePlus's list (MedlinePlus). Gallstones are covered in our guide to gallstones in Black women.

See a doctor promptly for new yellowing of the whites of your eyes as an adult, even if you feel well, because MedlinePlus notes jaundice is often a sign of a problem with the liver, gallbladder or pancreas (MedlinePlus). Get care the same day if you may have taken more acetaminophen than the label allows, since an overdose is one of the listed causes, or if the yellowing comes with dark urine, tiredness and a fast heartbeat, signs MedlinePlus links to red blood cells breaking down (MedlinePlus).

For a new, growing or one-sided dark spot on the white of the eye, book an eye exam with an ophthalmologist or optometrist. You can find an ophthalmologist in our directory, and our guide to eye exams without insurance covers lower-cost options.