The sclera is normally dull white like porcelain. Altered color suggests one of the following changes:
❖ Conjunctival and/or ciliary injection and inflammation will give the sclera a red appearance.
❖ A sclera that is very thin will appear blue because of the underlying choroid (this occurs in the newborn, in osteogenesis imperfecta, and following inflammation; see Fig. 6.4).
❖ In jaundice, the sclera turns yellow.
❖ In ochronosis (alkaptonuria), the sclera will take on brownish color. This should be distinguished from pigmented changes in the conjunctiva.
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