Letters to the Editor

Use of the Term Conjunctival Icterus Instead of Scleral Icterus

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Am Fam Physician. 2005 Jan 1;71(1):49.

to the editor: I read with great interest the article1 on jaundice in the adult patient in the January 15, 2004, issue of American Family Physician. It was a very informative and useful article. However, I noticed the authors used the term “scleral icterus.” This is a term that is commonly used in textbooks; however, from a histopathologic perspective, it is a misnomer. Bilirubin has a high affinity for elastin which is an abundant protein in the conjunctivae as well as the superficial, fibrovascular episclerae, but not the sclerae proper.2 A more accurate description would therefore be conjunctival icterus.


1. Roche SP, Kobos R. Jaundice in the adult patient. Am Fam Physician. 2004;69:299–304.

2. Kuiper JJ. Conjunctival icterus. Ann Intern Med. 2001;134:345–6.

Send letters to Kenneth W. Lin, MD, MPH, Associate Deputy Editor for AFP Online, e-mail: afplet@aafp.org, or 11400 Tomahawk Creek Pkwy., Leawood, KS 66211-2680.

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