Blue Sclera – Healthnile.com

Blue sclera happens when the normally white part of the eye takes on a bluish tint. This change often occurs because the sclera becomes thinner, allowing the underlying tissue to show through. Certain genetic conditions, health problems, or even medication side effects can cause this change.

Some people inherit blue sclera from conditions like osteogenesis imperfecta or Ehlers-Danlos syndrome. Others develop it later in life from iron deficiency, collagen disorders, aging, or specific medications. In each case, the underlying cause affects the structure or thickness of the sclera.

Definition of Symptom

Blue sclera is a visible change in the sclera, the white, outer layer of the eye. In this condition, the sclera appears blue, bluish-gray, or blue-purple instead of its usual white color. When the sclera becomes thinner than normal, the darker tissue underneath, called the uvea or choroid, shows through.

Blue sclera can be present at birth or develop later in life. In infants, the sclera is naturally thinner, so a mild bluish tint can be normal and may fade with age. In adults, blue sclera often has an underlying cause such as a genetic connective tissue disorder, nutritional deficiency, or medication side effect. Key points about the symptom:

Feature	Description
Location	White outer layer of the eye (sclera)
Appearance	Blue, bluish-gray, or blue-purple tint
Possible Onset	At birth or acquired later
Cause	Thinning of scleral tissue

Some people notice the color change in both eyes, while in rare cases it affects only one. The degree of blueness can vary depending on lighting, the thickness of the sclera, and the underlying cause. While blue sclera is sometimes harmless, it can also be a sign of a condition that requires medical evaluation.

Possible Causes/Diseases Condition

Several health conditions can lead to blue sclera by affecting the thickness or structure of the eye’s white outer layer. When the sclera becomes thinner, the underlying tissue shows through, giving it a bluish tint.

Genetic disorders are a common cause. Osteogenesis imperfecta (also called brittle bone disease) weakens bones and connective tissue, often leading to fractures and blue sclera.
Ehlers-Danlos syndrome is another connective tissue disorder linked to blue sclera. People with this condition may also have very flexible joints and fragile skin. Marfan syndrome can cause similar connective tissue changes, sometimes affecting the eyes.
Certain autoimmune diseases can also play a role. In rheumatoid arthritis, inflammation can damage the sclera and make it appear bluish over time.

Condition	Type	Possible Effect on Sclera
Osteogenesis imperfecta	Genetic	Thinning, blue tint
Ehlers-Danlos syndrome	Genetic	Thinning, increased fragility
Marfan syndrome	Genetic	Connective tissue changes
Rheumatoid arthritis	Autoimmune	Inflammation, discoloration

Blue sclera may also appear with iron deficiency anemia or other systemic health problems, though these are less common than connective tissue disorders.

Other Non-Disease Causes

Not all cases of blue sclera come from genetic or chronic diseases. Medications, minor eye changes, or nutritional issues can also cause it. These causes may be temporary or reversible once the source is addressed. Certain medications can tint the sclera blue or gray. Examples include:

Medication	Common Use	Notes
Tetracycline antibiotics	Antibiotic for acne/infection	Color change may fade after stopping
Antineoplastic agents	Cancer treatment	May cause bluish eye discoloration
Phenothiazine antipsychotics	Antipsychotic medications	Long-term use can affect eye color
Antiarrhythmic medications	Heart rhythm control	May cause corneal and scleral changes
Anticonvulsants	Seizure control	Rarely linked to scleral tint

Nutritional factors can also play a role. Iron deficiency anemia may thin the sclera, letting the darker tissue underneath show through. Iron supplements and diet changes can help restore normal appearance over time.

Some benign eye conditions may create a bluish or grayish look. A nevus (pigmented spot) on the sclera or nevus of Ota can give parts of the eye a darker hue. These are usually harmless but should be monitored for changes.

A pinguecula—a small, yellowish growth on the sclera—does not cause a blue color itself, but surrounding tissue may appear slightly discolored due to contrast. This is more common in people with frequent sun or wind exposure.

How It Causes the Symptom

Blue sclera appears when the sclera — the white outer layer of the eye — becomes thinner than normal. This thinning makes the tissue more transparent. As a result, the darker layer beneath, called the uvea or choroid, becomes visible, giving the sclera a bluish tint.

Reduced or abnormal collagen production is a main reason for scleral thinning. Collagen is a strong protein that helps maintain the eye’s shape and strength. When collagen fibers are fewer or weaker, the sclera loses thickness and strength.

Certain genetic conditions, such as osteogenesis imperfecta or Ehlers-Danlos syndrome, affect how the body makes or structures collagen. This leads to weaker connective tissue throughout the body, including in the eyes. Other possible factors include:

Aging: Natural collagen loss over time can thin the sclera.
Inflammatory Eye Diseases: Long-term inflammation may damage scleral tissue.
Certain Medications: Some drugs, like prolonged corticosteroid use, can reduce collagen strength.

Condition	Effect on Collagen	Result in Eye Appearance
Genetic collagen disorder	Poor collagen quality	Blue sclera from birth or early life
Age-related change	Gradual collagen loss	Mild blue or gray tint in later years
Inflammation or injury	Collagen breakdown	Localized blue areas in sclera

When the sclera is thin, even small changes in underlying tissue color become visible. This physical change, not pigment in the sclera itself, creates the blue appearance.

Possible Complications

Blue sclera itself is a sign, not a disease, but it can be linked to eye and health problems that may need medical care. Some complications come from the underlying cause rather than the color change.

Vision changes can occur if the condition is related to connective tissue disorders or other eye diseases. People may notice blurred vision, reduced sharpness, or changes in how they see colors.
Light sensitivity (photophobia) may develop, especially if the cornea or sclera is thinner than normal. This can make it uncomfortable to be in bright environments.
Glaucoma is a possible risk in certain genetic conditions that also cause blue sclera. Increased eye pressure can damage the optic nerve over time.
Cataracts may appear earlier in life in some people with related disorders. This clouding of the lens can lead to gradual vision loss if untreated.
Scleritis, or inflammation of the sclera, can cause pain, redness, and swelling. It may also worsen the bluish appearance.

Other potential issues include:

Complication	Possible Effect
Eye discharge	May signal infection or inflammation.
Subconjunctival hemorrhage	Small blood vessel breaks can cause red patches.
Retinal detachment	Can lead to sudden vision loss and requires urgent care.

Because blue sclera can be linked to systemic conditions, some complications may also affect joints, bones, or other organs. Eye exams and medical evaluations help detect these problems early.

When to Seek Medical Attention

A blue tint in the sclera is not always serious, but it can signal an underlying health issue. If the color change appears suddenly or gets worse over time, see a healthcare provider.

Schedule an eye exam with an eye doctor if the discoloration does not go away. An eye exam can show whether the cause is harmless or linked to a health problem. Seek prompt care if the blue sclera comes with:

Eye pain, redness, or swelling
Changes in vision
Frequent bone fractures or joint pain
Other unexplained symptoms

During an evaluation, the provider may order:

Test	Purpose
Eye exam	Checks eye structure and health.
Blood tests	Looks for signs of disease.
Genetic testing	Finds inherited conditions.
Imaging scans	Reviews bone or connective tissue health.

If an infant or child has blue sclera, schedule a pediatric eye exam. In young children, the sclera can look naturally thinner, but ongoing or deep discoloration should still be checked. Adults who notice new discoloration should contact an eye care professional.