Why Do My Sclerae Appear Blue After Waking Up?

Why do the whites of the eyes (sclera) appear blue after waking up?

Hello Dr.
Chang, I recently woke up one morning and noticed that the sclera (the white part of my eye) appeared light blue.
After asking a few friends, one explanation was that it might be due to having slept well the previous night, similar to how infants often have a light blue sclera.
Another, more scientific explanation suggested it could be due to chronic iron deficiency or anemia.
I would like to understand the actual reason for this.
Thank you for taking the time to help me with this!

A-Ren, 20~29 year old female. Ask Date: 2008/04/14

Dr. Zhang Yanrui reply Ophthalmology

The blue appearance of the sclera is due to a thinner sclera, which allows the underlying uveal tract's color to show through.
The likelihood of the sclera suddenly turning blue is very low, unless there is necrotizing scleritis, which would be quite painful and uncomfortable.
In most cases, the sclera has always been thinner, but it may not have been noticed before.
Anemia does not cause the sclera to turn blue; rather, insufficient blood flow can make the sclera appear paler.

Reply Date: 2008/04/14

More Info

The appearance of blue sclerae (the white part of the eye) upon waking can be attributed to several factors, and understanding these can help clarify your concerns.
Firstly, the blue tint in the sclera can be a normal anatomical variation, particularly in younger individuals or those with lighter skin tones. In infants, the sclera often appears bluish due to the thinness of the conjunctival tissue and the underlying choroidal blood vessels, which can show through more prominently. As we age, the sclera tends to become thicker and more opaque, reducing this bluish appearance.

However, if you are noticing this change in your sclerae as an adult, particularly if it is a new development, it may warrant further investigation. One possible explanation is related to the vascularity of the eye. When you wake up, the sclera may appear blue due to the pooling of blood in the conjunctival vessels, especially if you have been lying down for an extended period. This can be more pronounced if you have been sleeping in a position that restricts blood flow or if there is increased pressure in the head and neck area.

Another consideration is the potential for underlying health issues. Conditions such as iron deficiency anemia can lead to paleness of the conjunctiva and sclera, but they typically do not cause a blue appearance. However, if there is significant anemia, the overall health of the eye may be affected, leading to changes in appearance. Additionally, certain connective tissue disorders, such as osteogenesis imperfecta, can cause a blue sclera due to the thinning of collagen in the scleral tissue.

If you have experienced other symptoms such as fatigue, weakness, or changes in vision, it would be prudent to consult with a healthcare professional. They may recommend blood tests to check for anemia or other underlying conditions that could be contributing to the change in your sclerae's appearance.

In summary, while a blue tint to the sclera upon waking can be benign and related to normal anatomical variations or temporary vascular changes, it is essential to monitor for any accompanying symptoms. If the change persists or is associated with other concerning signs, seeking medical advice is advisable to rule out any underlying health issues.

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