hemolacria

Hemolacria, from Greek haima meaning blood and dakryon meaning tear, is a rare condition in which tears contain blood. It has been reported in people of all ages and can present as episodes of bloody tears that may be unilateral or bilateral. In many cases the cause remains unknown, but identifiable ocular or systemic factors can be found.

At presentation, patients may notice blood-tinged tears during crying or spontaneously. Symptoms can include ocular redness, irritation, discharge, or a sensation of fullness nearby; in some cases there is no pain. When a lesion of the eyelid, conjunctiva, lacrimal gland, or nasolacrimal system is present, bleeding may accompany tear production.

Causes are diverse. Local ocular causes include conjunctival or lacrimal gland tumors, vascular malformations, conjunctival hemorrhage, trauma, surgery, and infections. Systemic factors include bleeding disorders such as von Willebrand disease or thrombocytopenia, use of anticoagulants, and, less commonly, severe hypertension. Rare associations with nasolacrimal duct obstruction or orbital vascular anomalies have been reported.

Diagnosis relies on history and ophthalmic examination to locate a bleeding source, aided by slit-lamp microscopy. Laboratory testing (complete blood count and coagulation studies) and imaging (ultrasound, CT, or MRI) may be indicated if a mass, vascular abnormality, or systemic coagulopathy is suspected.

Management focuses on treating the underlying cause. If no cause is found and bleeding resolves spontaneously, observation may be appropriate. The prognosis depends on the etiology; some cases remit without intervention, while others require targeted treatment of ocular lesions or systemic disorders.