16 December 2018


Most reports of bleeding in the eyes refer to cases of subconjunctival hemorrhage.  This report, from the archives of the New England Journal of Medicine, is the first I've seen with frank external bleeding.
A 52-year-old man presented to the emergency department with painless, bloody tears from both eyes. The bleeding had begun spontaneously approximately 2 hours earlier, had lasted a few minutes, and had recurred just before presentation. He reported no orbital, ocular, or nasal trauma and no history of bloody tears, epistaxis, gingival bleeding, or easy bruising. He was taking captopril for mild hypertension, and his blood pressure at examination was normal. The clinical examination revealed slight conjunctival hyperemia without periorbital or palpebral edema. The patient had normal vision and extraocular movements. The bloody appearance of the tears stopped spontaneously within 1 hour after presentation. Slit-lamp examination revealed hemangiomas on the inside of both eyelids. Hemolacria is a rare condition that is characterized by the presence of blood in the tears. Bleeding associated with tears can occur in the context of infection, inflammation, or trauma to the eye or surrounding structures, vascular tumors of the eye or surrounding structures, or retrograde epistaxis. For the eyelid hemangiomas, the patient began using timolol ophthalmic drops. At 1 year of follow-up, the patient had had no further episodes of bloody tears.
Other cases have been reported to be factitious disorders or Munchausen by proxy episodes.

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