Sunday Medical Tip

An update to correct terminology for a common physical sign (good tip for medical and nursing students)

When you see this in a patient and you write your observations in the medical record or are conversing with a colleague about this physical finding, what do you call it? If you said “scleral icterus” you are technically incorrect.

I entered medical school in 2000 (believe it or not. And it seems like yesterday), and when I saw this finding I would call it “scleral icterus”. Nearly 24 years later, you could find me writing “scleral icterus” in autopsy reports. And believe me, this is a very common thing to see at autopsy since we investigate so many deaths in which the decedent has cirrhosis due to chronic hepatitis or chronic alcoholism. But the term is actually a misnomer because the deposition of bilirubin that results in the yellow color actually occurs in the conjunctival membranes overlying the sclera (the whites of the eyes). So if you want to be absolutely precise, you would say “conjunctival icterus”. But I tell you this with a warning:

Your preceptors, no matter what field of medicine/health care you are in, may try to correct you. Remember, the term ‘scleral icterus’ has been used for well over a hundred years and it is ingrained in the minds of those that trained before you. And ultimately it doesn’t matter that much but as an attending of mine used to say “yes, but you want to be precise.”

So, if you’re asked to describe this finding, scleral icterus isn’t going to get you in trouble, but the more appropriate term is conjunctival icterus. As is often the case in medicine, you can always alter your description to still be technically correct: “The sclerae appear yellow due to conjunctival icterus.” 😄

— DLW