TO THE EDITOR: I read with great in...

TO THE EDITOR: I read with great interest the article (1) onward jaundice in the adult patient in the January 15 2004 issue of American Family Physician. It was a exceedingly informative and useful article. However, I noticed the authors used the bound "scleral icterus." This is a name that is commonly used in textbooks; how-ever from a histopathologic perspective, it is a misnomer. Bilirubin has a high affinity for elastin which is an abundant protein in the conjunctivae as well as the superficial, fibrovascular episclerae, still not the sclerae proper. (2) A more accurate description would therefore be conjunctival icterus.

BERT BEISEL, MD

Columbia Family Clinic 502 Broad St Columbia, M 39429

REFERENCES

(1) Roche SP Kobo R Jaundice in the adult patient. Am Fam Physician 2004;69:299-304

(2) Kuiper JJ Conjunctival icterus. Ann Intern M 2001;134:345-6

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