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Am Fam Physician. 2005;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.

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This series is coordinated by Kenny Lin, MD, MPH, deputy editor.

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