Why Do The Whites Of My Eyes Look Blue?

Why Do The Whites Of My Eyes Look Blue
Sclera: Definition, Anatomy & Function The sclera, or white of the eye, is strong tissue that wraps around the eyeball. It helps maintain your eyeball’s shape and protects it from injury. Several things can make the entire sclera change color or cause spots of color. Many scleral conditions resolve on their own in a few weeks, but some require medical attention. The sclera wraps around the eyeball. The sclera, or white of the eye, is a protective covering that wraps over most of the eyeball. It extends from the in the front to the optic nerve in the back. This strong layer of tissue, which is no more than a millimeter thick, gives your eyeball its white color.

It also protects and supports your eye. The plural for sclera is sclerae. The sclera functions as the supporting wall of the eyeball. It helps maintain your eyeball’s shape, and protects it from injury. The sclera is covered by conjunctiva, which are clear mucus membranes that lubricate (moisturize) your eye.

Muscles attached to the sclera help move your eyeball up and down and side to side. The sclera is made of tough collagen fibers, which crisscross in random directions. That random pattern gives your eyeball its white color and gives the sclera strength.

Episclera, clear, thin tissue resting on top of the whites of your eyeballs. Stroma, made up of fibroblasts and collagen fibers, blending into the episclera. Lamina fusca, a transitional layer between the sclera and the choroid and ciliary body outer layers. Endothelium, the basal, or innermost layer of the sclera.

Several things can cause the entire sclera to change color or spots of color to appear:

Blue sclera: If the sclera is thinner than normal, blood vessels may show through, giving your eyeballs a blue or gray hue. This may occur in people with certain health conditions. Examples include (a genetic bone disease) and (a disorder in connective tissue throughout the body). Other examples include iron deficiency and, Icteric sclera and jaundice: If the entire sclerae turn yellow, that could mean you have, Jaundice indicates liver disease, which means the liver isn’t filtering blood properly. Injury: If your eyeball is injured, it may have a bright red spot. This indicates a broken blood vessel that has leaked some blood. These red spots are usually harmless and go away in a few days or weeks. Irritation: If your eyes are “bloodshot,” you can see redness throughout the sclerae. Eyes may be irritated due to smoke, allergies, exhaustion or infection. Medication: Some medications can tint the sclerae blue or gray (for example, an antibiotic called minocycline). Melanosis: Your sclera may contain a flat, brown spot, almost like a freckle. This is more common in Black people. The spots are caused by high levels of pigment called melanin, and they’re harmless. Pinguecula: A small patch of yellow may bulge out from your sclera after damage from the sun, wind or dust. The patch may become inflamed and turn pink or red. Pterygium: If a pinguecula goes untreated, it can get larger, expand into the cornea and block vision. Primary acquired melanosis (PAM): If you have a flat brown spot on the eye that changes over time, this may indicate PAM. This condition can become cancerous, so report any new or changing spots on the sclera.

How do I stop blue sclera?

Bilateral fractures of acetabulum in a young girl with osteogenesis imperfecta and epilepsy

CASE REPORT

Year : 2017 | Volume : 29 | Issue : 3 | Page : 240-243

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Blue sclera and osteogenesis imperfecta – A rare association, Department of Ophthalmology, Andaman and Nicobar Islands Institution of Medical Science, Port Blair, Andaman and Nicobar Islands, India

Date of Web Publication

30-Jan-2018

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Correspondence Address :Dr. Sujit DasDepartment of Ophthalmology, MS Ophthalmology, ANIIMS, Port Blair, Andaman and Nicobar Island, Islands India

Source of Support: None, Conflict of Interest: None

DOI: 10.4103/kjo.kjo_75_17 The sclera is a dense poorly vascularized connective tissue structure composed of Types I, III, IV, V, VI, and VIII collagen. The characteristic blue sclera is caused by thinness and transparency of the collagen fibers of the sclera that allow visualization of the underlying uvea.

How to cite this article: Das S, Bhatnagar K. Blue sclera and osteogenesis imperfecta – A rare association. Kerala J Ophthalmol 2017;29:240-3

The sclera is a dense poorly vascularized connective tissue structure composed of Types I, III, IV, V, VI, and VIII collagen, as well as elastin, proteoglycans, and glycoproteins. The characteristic blue sclera is caused by thinness and transparency of the collagen fibers of the sclera that allow visualization of the underlying uvea. The sclera may be thinned in congenital diseases such as osteogenesis imperfecta (OI) or in acquired diseases such as iron deficiency anemia. Severe forms are most often diagnosed early in life, but mild cases may not be noted until later in life. The blue-gray color of the sclera is due to the underlying choroidal veins which show through. This is due to the sclera being thinner than normal because the defective Type I collagen is not forming correctly. Epidemiology In the United States, the incidence of OI is estimated to be one per 20,000 live births. An estimated 20,000-50,000 people are affected by OI in the United States. Pathophysiology People with OI are born with defective connective tissue, or without the ability to make it, usually because of a deficiency of Type I collagen. This deficiency arises from an amino acid substitution of glycine to bulkier amino acids in the collagen triple helix structure. As a result, the body may respond by hydrolyzing the improper collagen structure. If the body does not destroy the improper collagen; the relationship between the collagen fibrils and hydroxyapatite crystals to form bone is altered, causing brittleness. As a genetic disorder, OI has historically been viewed as an autosomal dominant disorder of Type I collagen. Most cases have been caused by mutations in the COL1A1 and COL1A2 genes. In the past several years, there has been the identification of autosomal recessive forms. At least seven subsets have been described although four major subtypes are most common and range from mild to severe. Individuals with Type I OI have little bone deformity, persistent blue sclera, near normal height by adulthood, and a >50% chance of hearing loss by adulthood. Patients with perinatal lethal (Type II) OI show the greatest severity, with multiple fractures in utero or from the delivery. These patients usually are stillborn or die early. The severity of OI depends on the specific gene defect. Most cases of OI are inherited from a parent. However, some cases are the result of new genetic mutations. A person with OI has a 50% chance of passing on the gene and the disease to his or her children. Symptoms The fact that most of the children plus the mother have blue sclera should lead you to a genetic link. The findings of developmental delay, iron deficiency, and dental caries and one child’s history of a fracture should lead you to review the various presentations of OI. All people with OI have weak bones, and fractures are more likely. People with OI often have short stature because of their compressive leg fractures. However, the severity of the disease varies greatly.The classic symptoms include:

Blue tint to the whites of their eyes (blue sclera)
Multiple bone fractures
Early hearing loss (deafness).

Because Type I collagen is also found in ligaments, people with OI often have loose joints (hypermobility) and flat feet. Symptoms of more severe forms of OI may include:

Bowed legs and arms
Kyphosis
Scoliosis (S-curve spine).

Exams and tests
Possible complications
Complications are largely based on the type of OI present.

OI is most often suspected in children whose bones break with very little force. A physical exam may show that the whites of their eyes have a blue tint. A definitive diagnosis may be made using a skin punch biopsy. Family members may be given a DNA blood test.

Hearing loss (common in Type I and Type III)
Heart failure (Type II)
Respiratory problems and pneumonia due to chest wall deformities
Spinal cord or brain stem problems
Permanent deformity.

Outlook (prognosis) How well a person does depends on the type of OI they have.

Type I, or mild OI, is the most common form. People with this type can live a normal lifespan
Type II is a severe form that often leads to death in the first year of life
Type III is also called severe OI. People with this type have many fractures starting very early in life and can have severe bone deformities. Many people need to use a wheelchair and often have a somewhat shortened life expectancy
Type IV, or moderately severe OI, is similar to Type I, although people with Type IV often need braces or crutches to walk. Life expectancy is normal or near normal.

Treatment There is not yet a cure for this disease. However, specific therapies can reduce the pain and complications from OI. Drugs that can increase the strength and density of bone are called bisphosphonates. Low-impact exercises, such as swimming, keep muscles strong and help maintain strong bones.

People with OI can benefit from these exercises and should be encouraged to do them. In more severe cases, surgery to place metal rods into the long bones of the legs may be considered. This procedure can strengthen the bone and reduce the risk for fracture. Bracing can also be helpful for some people.

Surgery may be needed to correct any deformities. This treatment is important because deformities (such as bowed legs or a spinal problem) can interfere with a person’s ability to move or walk. Prevention Genetic counseling is recommended for couples considering pregnancy if there is a personal or family history of this condition.

A 32 years old male patient of Andaman & Nicobar Island reported to our OPD with an enquiry of his blue colouration of both eyes and whether this will transmitted to his next generation or not if married.
On history he had it since his childhood without associate with any visual complaints, hearing defect, any bony pain except for bony deformity of both hands.

He had short legs after an accidental fall from a height of 15 feet at the age of 8 years old. On enquiry there was a compressive fracture of both legs. There was no associated blue sclera running in the family. On examination his best corrected (BCVA) was 6/6 in both eyes; intraocular pressure in both eyes was 15 mmHg.

On anterior segment examination lids were normal, extra ocular movements was normal, there was blue sclera in eyes, cornea, conjunctiva and lens was normal.
On dilated eye examination fundus was normal.
On systemic examination he had bow arms, short legs, no spinal cord and chest deformity.
X-ray both hands shows arm deformity,

There was no gait abnormality. This patient was then sent to orthopaedic OPD for further evaluation.

Figure 1: Blue sclera

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Figure 2: Arms deformity

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Figure 3: Short legs

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Figure 4: X-ray shows arms deformity

The sclera may be thinned in congenital diseases such as OI or in acquired diseases such as iron deficiency anemia.
Severe forms are most often diagnosed early in life, but mild cases may not be noted until later in life.
People with OI are born with defective connective tissue, or without the ability to make it, usually because of a deficiency of Type I collagen.

This deficiency arises from an amino acid substitution of glycine to bulkier amino acids in the collagen triple helix structure. The relationship between the collagen fibrils and hydroxyapatite crystals to form bone is altered in OI, causing brittleness of bones.

As a genetic disorder, OI has historically been viewed as an autosomal dominant disorder of Type I collagen.
Most cases have been caused by mutations in the COL1A1 and COL1A2 genes.
Diseases associated with blue sclera includes multiple connective tissue disorders, such as Marfan syndrome, Ehlers–Danlos syndrome, OI, pseudoxanthoma elasticum, and Willems De Vries syndrome, to name a few.

Bone and blood disorders also on the list include Diamond–Blackfan anemia, severe iron deficiency anemia, Juvenile Paget’s disease, and acid phosphatase deficiency. Most cases of OI are inherited from a parent. However, some cases are the result of new genetic mutations.

A person with OI has a 50% chance of passing on the gene and the disease to his or her children. Prognosis depends on the type of disease – Type I is the most common and have normal life expectancy, whereas Types II–IV are severe one. Still now, there is no cure of this disease. Genetic counseling is recommended for couples considering pregnancy if there is a personal or family history of this condition.

Blue sclera may be associated with multisystem disorders so good history taking is most important. Most dreaded complication associated are OI, cardiac abnormalities, and hearing defects. Osteogenesis imperfecta is a autosomal disorder, and genetic counseling is recommended for couples considering pregnancy if there is a personal or family history of this condition.

Declaration of patient consent
Financial support and sponsorship
Conflicts of interest

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.Nil.There are no conflicts of interest.

	Rauch F, Glorieux FH. Osteogenesis imperfecta. Lancet 2004;363:1377-85.
	Glorieux FH, Rauch F, Plotkin H, Ward L, Travers R, Roughley P, et al, Type V osteogenesis imperfecta: A new form of brittle bone disease. J Bone Miner Res 2000;15:1650-8.
	Glorieux FH, Bishop NJ, Plotkin H, Chabot G, Lanoue G, Travers R. Cyclic administration of pamidronate in children with severe osteogenesis imperfecta. N Engl J Med 1998;339:947-52.
	Kelly M, Evelyn B. Encyclopedia of Human Genetics and Diseases. J Bone Miner Res 2014;27:1524-30.
	Dwan K, Phillipi CA, Steiner RD, Basel D. Bisphosphonate therapy for osteogenesis imperfecta. J Bone Miner Res 2012;14:1645-48.
	Harrington J, Sochett E, Howard A. Update on the evaluation and treatment of osteogenesis imperfecta. Pediatr Clin North Am 2014;61:1243-57.
	Sillence DO, Senn A, Danks DM. Genetic heterogeneity in osteogenesis imperfecta. J Med Genet 1979;16:101-16.
	Shapiro JR, Lietman C, Grover M, Lu JT, Nagamani SC, Dawson BC, et al. Phenotypic variability of osteogenesis imperfecta type V caused by an IFITM5 mutation. J Bone Miner Res 2013;28:1523-30.

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Bilateral fractures of acetabulum in a young girl with osteogenesis imperfecta and epilepsy

Can you make the whites of your eyes whiter?

What’s in Eye-Whitening Drops? – For years, the leading eye -whitening product was tetrahydrozoline, which you know by its over-the-counter name, Visine. It works by opening arteries in your eyes. In 2017, the FDA OKd a low-dose version of brimonidine tartrate, which was first prescribed to treat glaucoma,

Is blue sclera a disease?

Sir, A 16-year-old boy was referred to our department for ruling out a metabolic bone disorder. He presented to the emergency with an elbow fracture due to a fall on out-stretched hand. He denied history of recurrent fractures, deafness, skeletal deformities, and dentition abnormalities.

His past medical history was otherwise normal and none of the immediate family members had history of fractures. Systemic examination was unremarkable except for the fracture olecranon process on the right side. Ophthalmic examination revealed bluish sclera (Panel A) involving the right eye (Panel B) as shown in Figure 1,

His visual acuity, field of vision, color vision, pupillary reflexes, and extraocular movements were normal in both eyes. Skeletal survey and markers of bone metabolism were normal. He was diagnosed as a case of idiopathic unilateral bluish sclera and was kept under follow-up. Bluish sclera of right eye (a) in close up (b) Bluish sclera is associated with osteogenesis imperfecta, Marfan’s syndrome, Ehlers Danlos syndrome, Blue sclera syndrome (Van der Heave syndrome), incontinentia pigmenti, and many other inherited conditions.

The sclera is involved bilaterally in all these conditions and the unilateral appearance is a rarity. Unilateral bluish sclera is reported earlier with nevus depigmentosus, familial, and idiopathic in origin. The bluish hue of the sclera is due to the thinning of the collagen fibers and increased transparency which exposes the underlying uvea.

The bluish sclera, therefore, is seen in many conditions with the defective type 1 collagen formation. Osteogenesis imperfecta is the classical condition associated with the bluish sclera. However, our patient did not have any features to suggest the same.

It is essential to screen for musculoskeletal and connective tissue abnormalities in patients with blue sclera. Declaration of patient consent The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal.

The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

How can I whiten my sclera naturally?

Bright white eyes are a sign of good health and are very desirable as well, while tired, dull and bloodshot eyes can be as a result of fatigue, lack of sleep, long working hours, nutritional deficiency, excessive drinking, dehydration, smoking and even serious health problems like a weak liver. The white part of the eye Bright white eyes are a sign of good health and are very desirable as well, while tired, dull and bloodshot eyes can be as a result of fatigue, lack of sleep, long working hours, nutritional deficiency, excessive drinking, dehydration, smoking and even serious health problems like a weak liver.

The white part of the eye is called the Sclera and a milky-white sclera is often linked with good health and beauty.
It’s usually the first part of the eyes to show signs of aging.
While extreme cases should be referred to an optician or medical professional, these simple ways work to clear the eyes; 1.

Tea Bags: Simply dip 2 bags of either green or black tea in a mug of hot water for 5 minutes, remove the tea bags, squeeze out the excess water and put them in the fridge for about 10 mins or a little more. Place the chilled teabags over closed eyes and let them sit for 5 minutes.2.

Cucumber: Cut a few thick slices of cucumber and put them in the refrigerator for 15 to 20 minutes. Then, put the chilled slices over the closed eyelids until they become warm. Rinse eyes with water.3. Eat Enough Fruits And Vegetables: Orange and yellow fruits and vegetables, such as carrots, pumpkins, lemons and oranges, contain vitamins and antioxidants that will help keep your eyes white.

Eating green, leafy foods like spinach and kale also have a positive effect on your eye health.4. Get Adequate Sleep: It is greatly recommended that you get at least 7 to 8 hours of sleep every night because getting enough sleep every night will ensure that your body is rested and consequently that your eyes are rested and restored to their natural white color.

Can you change your sclera color?

Safe Eye Color Change

Keratopigmentation is a novel procedure that permanently changes the color of the eye by means of creating an intracorneal tunnel with the aid of a femtosecond laser and inserting a special pigment in front of the natural pigment of the eye.This procedure doesn’t involve the opening of the eye and therefore avoids intraocular complications like hemorrhages, infection, retinal detachment, and glaucoma.Automated with the highest precision laser technology, the procedure is performed under topical anesthesia with eye anesthetic drops and is not painful.

Can blue sclera be normal?

Sclera: Definition, Anatomy & Function The sclera, or white of the eye, is strong tissue that wraps around the eyeball. It helps maintain your eyeball’s shape and protects it from injury. Several things can make the entire sclera change color or cause spots of color. Many scleral conditions resolve on their own in a few weeks, but some require medical attention. The sclera wraps around the eyeball. The sclera, or white of the eye, is a protective covering that wraps over most of the eyeball. It extends from the in the front to the optic nerve in the back. This strong layer of tissue, which is no more than a millimeter thick, gives your eyeball its white color.

Several things can cause the entire sclera to change color or spots of color to appear: