Haemolacria or bloody epiphora is the presence of blood in the tear.
Alternative names of the condition include bloody tears, blood-stained tears, dacryohemorrhea, hematodacryorrhea, hemolacrimia, sanguineous tears, sanguineous lacrimation, hematic epiphora, dacryohemorrhysis, lacrimae cruentae, and tears of blood.
The source of blood in tears may be:
Haemolacria is a rare condition.
All patients presenting with haemolacria should undergo comprehensive ocular examination and systemic examination to look for organic causes and source of the hemorrhage. Specifically, the history of systemic diseases (hematological disorders, coagulopathies, hypertension) and medications like warfarin, aspirin or clopidogrel is necessary.
When no ocular or systemic causes are present, psychiatric diseases and vicarious menstruation must be ruled out before labeling the etiology as 'unknown' or 'idiopathic.'
When needed, imaging may give a clue to the cause of haemolacria. Dacryoendoscopy promises to be an important tool to rule out bleeding lesions within the tear drainage system which may be undetected without this modality.
The treatment of haemolacria depends on the cause. Close observation is needed when no apparent cause of haemolacria is detected to rule out malingering.
Differential diagnosis of haemolacria includes:
Severe bleeding through tears may even be fatal in some cases especially in a patient with coagulopathy. Ruling out hemorrhage from other sources including visceral bleeding is of utmost importance.
Haemolacria as such will not lead to complications. But it can be a complication of a multitude of conditions, as explained in the Etiology section.
If the patient is on anticoagulants for some systemic condition, the medication will have to be stopped or the dose reduced. The complications related to medication alteration require detailed explanation in conjunction with the physician or cardiologist.
Patients with haemolacria may first encounter their primary care provider, emergency department physician, or a nurse practitioner. Because there are many causes of the disorder, an ophthalmology consult is recommended. Cross-consultations with other physicians is usually needed to rule out any major systemic diseases. The outcomes of patients with haemolacria depend on the primary condition.
|||Murube J, Bloody tears: historical review and report of a new case. The ocular surface. 2011 Jul; [PubMed PMID: 21791186]|
|||Iovieno A,Coassin M,Piana S,De Luca M,Giunta P,Fontana L, A case of unilateral hemolacria. International ophthalmology. 2016 Apr; [PubMed PMID: 26506833]|
|||Abboud IA,Hanna LS, Bleeding from the conjunctiva. The British journal of ophthalmology. 1971 Jul; [PubMed PMID: 5557528]|
|||Gauba V,Cooper M,Liu C, Vicarious menstruation in primary localized conjunctival amyloidosis. Archives of ophthalmology (Chicago, Ill. : 1960). 2006 Sep; [PubMed PMID: 16966641]|
|||Singh A,Tripathy K,Gupta N,Kale P,Verma N,Mirdha BR, Phthirus pubis in the eye. Indian journal of medical microbiology. 2016 Jul-Sep; [PubMed PMID: 27514981]|
|||Wiese MF, Bloody tears, and more! An unusual case of epistaxis. The British journal of ophthalmology. 2003 Aug; [PubMed PMID: 12881360]|
|||Chon BH,Zhang R,Bardenstein DS,Coffey M,Collins AC, Bloody Epiphora (Hemolacria) Years After Repair of Orbital Floor Fracture. Ophthalmic plastic and reconstructive surgery. 2017 Sep/Oct; [PubMed PMID: 27879619]|
|||Ali MJ,Naik MN, Dacryoendoscopy in a Case of Unexplained Hemolacria. Ophthalmic plastic and reconstructive surgery. 2018 Nov/Dec; [PubMed PMID: 29905639]|
|||Bonavolontà G,Sammartino A, Bloody tears from an orbital varix. Ophthalmologica. Journal international d'ophtalmologie. International journal of ophthalmology. Zeitschrift fur Augenheilkunde. 1981; [PubMed PMID: 7266999]|
|||Macri A,Sharma S, Osler-Weber-Rendu Disease (Hereditary Hemorrhagic Telangiectasia, HHT) 2018 Jan; [PubMed PMID: 29493983]|
|||JIRICKA Z,VOLICER L, PRESENCE OF BLOOD IN TEARS DURING THE MECHOLYL TEST. Medicina et pharmacologia experimentalis. International journal of experimental medicine. 1965; [PubMed PMID: 14281478]|
|||Audelan T,Best AL,Ameline V, [Hemolacria: A pediatric clinical case report]. Journal francais d'ophtalmologie. 2019 Jan; [PubMed PMID: 30545679]|
|||Maurin O,Arvis AM,Lemoine S, Hemolacria in hypertensive crisis La Revue du praticien. 2015 Nov 20; [PubMed PMID: 30754966]|
|||Manzano G,Shantharam R,Webb E,Finelt N,Hengel K, Case 2: Hemolacria, Hematochezia, and Hematuria in an 11-month-old Boy. Pediatrics in review. 2018 Aug; [PubMed PMID: 30068743]|
|||Norn MS, Microscopically and chemically detected haemolacria. Acta ophthalmologica. 1977 Feb; [PubMed PMID: 576543]|