Sclera

Definition

The sclera is the tough, fibrous, white outer layer of the eyeball that provides structure and attachment for extraocular muscles. It continues anteriorly as the cornea.

Clinical Assessment

• Normal: White (may have small blood vessels).
• Yellow (icteric): Jaundice from elevated bilirubin.
• Red: Conjunctivitis, subconjunctival hemorrhage.
• Blue tint: Thin sclera (osteogenesis imperfecta, connective tissue disorder).

Significance

Scleral examination is particularly valuable in darker-skinned patients where skin jaundice is harder to detect, always assess sclera in natural light.

Nursing Interventions

Document any changes in color. Icteric sclera: investigate hepatic or hemolytic causes. Subconjunctival hemorrhage: usually benign, resolves in 1 to 2 weeks (avoid rubbing).

NCLEX Relevance

Assess sclera for jaundice in darker-skinned patients.