Weeping Blood/ Haemolacria

"Drops of blood were seen to be coming out from both the eyes [but] there was no injury to the eye."

"It was not accompanied by headache or giddiness ... There was no family history of such a condition."

"She lived happily with her family, according to her husband."

Researchers

Haemolacria is a condition characterised by the presence of blood in tears. The condition is also known as dacryohemorrhea, haemato-dacryorrhea and sanguineous lacrimation.1 It is one of the most alarming and rare conditions, which has been attributed to several etiologies. Due to its low incidence and limited literature, the prevalence and predilection of haemolacria for a specific gender, race or age remain obscure. Haemolacria was first mentioned in the scientific medical book, Aëtius of Amida, in the sixth century. A millennium later, in the 16th century, there was a nun who had auricular and ocular haemorrhages every month instead of menstruating, cited by Brassavola. Later in 1581, a 16-year-old girl was cited by Dondonaeus who had drops of bloody tears instead of menstrual discharge.1 Haemolacria is a benign and self-limiting condition. However, it has an association with severe systemic diseases like hereditary haemorrhagic telangiectasia or Osler-Weber-Rendu disease, Henoch-Schönlein purpura, Gardner-Diamond syndrome and bleeding disorders like haemophilia, characterised by deficiency of clotting factors like VIII and IX. Vascular causes like high blood pressure is one of the common causes of epistaxis. Epistaxis with retrograde flow of blood through puncta lacrimalia has been reported as a cause of haemolacria.2 Ocular conditions like conjunctival varicose vessels, inflammatory conditions like blepharitis, conjunctivitis, dacryoadenitis, inflammatory papillomas of conjunctival sac and episcleritis with bloody tears have been reported. Neoplasms like conjunctival hemangioma, meningioma of lacrimal sac and lymphangioma in upper cul-de-sac are also important causes of haemolacria.1 In haemolacria, sources of blood can be tear glands, the walls of lacrimal basin or puncta lacrimalia. Thorough evaluation should be done in patients of haemolacria before labelling it as idiopathic. Idiopathic haemolacria is basically a diagnosis of exclusion.3 According to the literature, other causes of haemolacria are trauma, vicarious menstruation, stress, anxiety, physical exertion, including stooping, bending and coughing. Drugs like silver nitrate and acetylcholine have been reported to cause haemolacria. Close observation and regular follow-up of a patient is helpful in diagnosing a psychiatric condition known as Munchausen syndrome, a rare cause of haemolacria.

British Medical Journal

The British Medical Journal (BMJ) recently published documentation of a case study that resulted out of a young woman, alarmed  to see blood being emitted from her eyes, rushed to hospital. She had been bathing, was menstruating, and looked up to a mirror to see herself seeping blood from both her eyes. She hadn't been injured, wasn't ill, and was not experiencing any other symptoms. This was the second time it had occurred, she informed researchers, and both times the episodes occurred when she had her period.

The 25-year-old was diagnosed with the rare disorder called Haemolacria, known coloquially as blood tears, a condition causing an individual to produce tears mixed with blood. No clear explanation exists for the condition that is relatively benign, but disturbing in its presentation. Theories abound that haemolacria may be caused by factors such as hormonal changes, inflammation, conjunctival injuries, high blood pressure and certain blood disorders.

In this particular case the doctors involved in the woman's treatment felt the condition might have been caused by 'vicarious menstruation', "a rare and unusual" occurrence where a woman's menstrual cycle results in blood occurring outside the uterus. Where women in their 30s and 40s are the most likely to have the experience which can feature as well, bleeding from the eyelids, retinas, ears, lungs and nipples. It has been known to occur even more rarely, in males.

A screenshot taken from a video of an 11-year-old girl leaking bloody tears. (BMJ Case Reports)

Various types of eye tissue can be affected by hormonal alterations in the body, according to researchers producing previous studies. Where the thickness and curve of the cornea can fluctuate during a menstrual cycle; alternately throughout pregnancy and lactation, with the potential to open odd avenues for blood to escape from the body, unusual as that may be.

A possible instability in the nervous system may also play a part in the phenomenon, according to other research; however whatever the cause the condition is  treatable with medication. Surgery is rarely needed to correct the syndrome. In this young woman's case her attending physicians diagnosed the condition expeditiously since her symptoms coincided with her menstrual cycle.

Leaving them to diagnose her with ocular vicarious menstruation. For which they prescribed oral contraceptives that resulted in her highly unusual problem disappearing.

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