Hemolacria or Bloody epiphora

               Hemolacria or Bloody epiphora

 Hemolacria or bloody epiphora is the presence of blood in the

 tear. Alternative names for the condition include bloody tears,

 blood-stained tears, dacryohemorrhea, hematodacryorrhea,  

hemolacrimia, sanguineous tears, sanguineous lacrimation,

 hematic epiphora, dacryohemorrhysis, lacrimae cruenate, and

 tears of blood. 

      Hemolacria or bloody epiphora is the presence of blood in

 tears Multiple disorders can cause Hemolacria. This activity

 reviews the evaluation and management of hemolacria and

 highlights the role of interprofessional team members in

 collaborating to provide well-coordinated care and enhance

 outcomes for affected patients. 

Etiology:

 The source of blood in tears may be: 

 Bleeding from the conjunctive- conjunctiva is a vascular tissue

 with limbal, bulbar, fornical, and palpebral parts. The

 conjunctival vessels lie at the ocular surface and may bleed

 spontaneously or after eye-rubbing, usually causing

 subconjunctival hemorrhage. 

Trauma:

  Conjunctival laceration or rupture of conjunctival vessels may

 cause hemolacria. Surgery involving incision or excision of the

 conjunctiva may also cause hemolacria. The surgeries include

 small incision cataract surgery, pterygium surgery, squint

 surgery, scleral buckling, and trabeculectomy. 

Inflammation:

 Severe conjunctivitis including hemorrhagic conjunctivitis,

 membranous or pseudomembranous conjunctivitis,

follicular conjunctivitis with congested semilunar fold and caruncle, severe viral or bacterial conjunctivitis cause blood-stained tears. 

Vascular Lesions: 

  Hemangioma, lymphangioma, inflammatory papilloma of the conjunctivitis sac, telangiectasia of conjunctival vessels, and pyogenic granuloma. 

Vicarious menstruation:

  The conjunctiva may periodically/cyclically bleed(Vicarious menstruation) during menstruation or hormonal disturbances. This phenomenon is usually seen around menarche or rarely around menopause. 

- Normal conjunctiva stimulated by hormonal or other factors. 

- Estrogenic premenstrual light blood hypertension. 

Foreign body:

  Foreign body at the upper fornix can cause chronic irritation, erosion of the conjunctiva, and hemolacria. Subconjunctival metallic splinter after trauma may cause bleeding into the tear. 

- Chemical injury- application of silver nitrate over the conjunctiva is another cause of bloody tears.

- Bleeding from the lid margin- Inflammed lid margin due to blepharitis may cause erosion of the surface of the eyelid and lead to bleeding. 

  Bleeding from the lacrimal puncta- The source of the bleeding in tears may be the puncta There is one lacrimal punctum, each at the medial side of the upper and lower lid, respectively. These are situated at the inner margin of the lid. Punctum connects medically to a lacrimal canaliculus on both the upper and lower lid. 

 - Other causes of bleeding from the lacrimal punctum include:

 - Trauma

- Infection

- Tumor- angioma, meningioma of the lacrimal sac. 

- Vascular lesions including varices and dacryolith, rupture of dilated/ distended vessels within the lacrimal sac. 

• Vascular disorders may play an important role in the pathogenesis of hemolacria. Hypertension is an important factor that has been reported to cause epistaxis and retrograde haemolacria through the leak of hemorrhage via the lacrimal puncta
• Other causes of haemolacria include
• Cranial trauma
• Post-traumatic epilepsy
• In otherwise normal individuals after stooping, or muscular effort
• In children after 'copious weeping.'
• Coughing
• Hypertensive crisis
• Acute hemorrhagic edema of infancy
• Unknown cause/idiopathic - In some cases, despite a thorough search for ocular, systemic, or psychiatric causes, no obvious etiology or source is found.

Prognosis:

 Severe bleeding through tears may even be fatal in some cases, especially in a patient with coagulopathy. Identifying hemolacria from systemic causes is of utmost importance. 

Complications:

 

 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. Identifying the cause and targeting the treatment towards it, is the most important step in the management of hemolacria. 

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