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PHOTO ESSAY
Year : 2020  |  Volume : 68  |  Issue : 4  |  Page : 638-639

Uncontrolled systemic hypertension and haemolacria


1 Department of Eye Care Services, Manipal Hospital, Salem, Tamil Nadu, India
2 Baroda Children Eye Care and Squint Clinic, Vadodara, Gujarat, India

Date of Submission04-Sep-2019
Date of Acceptance23-Oct-2019
Date of Web Publication16-Mar-2020

Correspondence Address:
Dr. G Seethapathy
Department of Eye Care Services, Manipal Hospital, Dalmia Board, Salem.Bangalore Highway, Salem . 636 012, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijo.IJO_1619_19

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Keywords: Blood in tears, haemolacria, hypertension, nasal packing


How to cite this article:
Seethapathy G, Jethani J. Uncontrolled systemic hypertension and haemolacria. Indian J Ophthalmol 2020;68:638-9

How to cite this URL:
Seethapathy G, Jethani J. Uncontrolled systemic hypertension and haemolacria. Indian J Ophthalmol [serial online] 2020 [cited 2020 Apr 2];68:638-9. Available from: http://www.ijo.in/text.asp?2020/68/4/638/280711



Haemolacria is a condition caused by a group of disorders resulting in production of tears that are partly composed of blood. It can be unilateral or bilateral. The etiology includes ocular, systemic, psychological, pharmacological, and idiopathic.[1],[2],[3]

We present an unusual case scenario of unilateral hemolacria in a 62-year-old previously fit and well gentleman who presented to ER (emergency consultation room) with sudden onset epistaxis from the right nostril. Immediate evaluation included local examination by an ENT (Ear Nose and Throat department) colleague and systemic evaluation by the physician. The Physician diagnosed severe hypertension (BP recorded was 190/110 mm hg) and antihypertensive therapy was initiated. The source of the nasal bleed was identified as the Little's area (Kiesselbach's plexus). An attempt to cauterize the bleed under local anesthesia was made by the ENT colleague, following which anterior nasal packing was done. Within a few minutes of packing the nose, patient started shedding blood mixed tears from the right eye (Haemolacria) [Figure 1]. The BP continued to stay high at 160/100 mm of Hg. Following this the antihypertensive measures were intensified resulting in complete resolution of the symptoms within the next 6 hours.
Figure 1: Shows blood mixed tears coming out of right eye of the patient. It shows right haemolacria and the free end/thread of the anterior nasal pack in the right nostril

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Preliminary ophthalmic evaluation revealed no local ocular causes of haemolacria, no previous trauma or lacrimal surgeries. We suspect retrograde blood flow through the Nasolacrimal duct to the conjunctival cul de sac following mechanical attempts at stopping the epistaxis, which alone was apparently ineffective as the underlying primary pathology was uncontrolled systemic hypertension. The authors also suspect a possible congenital absence of the valve of Hasner[4] or iatrogenic damage to the valve of Hasner at the inferior meatus at the time of primary mechanical attempts at haemostasis[5] that resulted in the above presentation. The patient was lost to further follow up thus preventing a further lacrimal outflow reassessment and a formal nasal endoscopic re-assessment.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Acknowledgement

Dr. Sujay Siddharthan, TMS Eye hospital.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Ahluwalia B, Khurana A, Sood S. Blood tears (Hemolacria). Indian J Ophthalmol 1987;35:41-3.  Back to cited text no. 1
[PUBMED]  [Full text]  
2.
Dillivan KM. Hemolacria in a patient with severe systemic diseases. Optom Vis Sci 2013;90:e161-6.  Back to cited text no. 2
    
3.
Khanna RK, Fontaine A, Lemacon JM, Moriniere S, Pisella PJ. Hemolacria revealing a primary nasolacrimal duct melanoma. Can J Ophthalmol 2019;54:e70-3.  Back to cited text no. 3
    
4.
Yedavalli V, Das D, Massoud TF. Eponymous “valves” of the nasolacrimal drainage apparatus. I. A historical review. Clin Anat 2019;32:41-5.  Back to cited text no. 4
    
5.
Serdahl CL, Berris CE, Chole RA. Nasolacrimal duct obstruction after endoscopic sinus surgery. Arch Ophthalmol 1990;108:391-2.  Back to cited text no. 5
    


    Figures

  [Figure 1]



 

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