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.
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