Firstly, scleral bluing can be caused by physiological or pathological reasons. If a patient is found to have a blue sclera, an ophthalmologist should first determine if it is pathological. If the sclera is pathologically blue, further investigations are required to determine the cause. Osteogenesis imperfecta, sclerochondritis and iron deficiency anaemia can all cause scleral blueness. There are treatments available for all of these conditions, so when you find a blue sclera, don’t be nervous, but seek prompt medical attention and active treatment.