Indian Journal of Ophthalmology

INTERESTING CASES
Year
: 1987  |  Volume : 35  |  Issue : 1  |  Page : 41--43

Bloody tears (haemolacria)


BK Ahluwalia, AK Khurana, S Sood 
 Department of Ophthalmology, Medical College Hospital, Rohtak 124 001, India

Correspondence Address:
B K Ahluwalia
Department of Ophthalmology, Medical College Hospital, Rohtak 124 001
India

Abstract

A case of bloody tears in a young hysterical female is described and rarity of the condition is stressed.



How to cite this article:
Ahluwalia B K, Khurana A K, Sood S. Bloody tears (haemolacria).Indian J Ophthalmol 1987;35:41-43


How to cite this URL:
Ahluwalia B K, Khurana A K, Sood S. Bloody tears (haemolacria). Indian J Ophthalmol [serial online] 1987 [cited 2020 Mar 30 ];35:41-43
Available from: http://www.ijo.in/text.asp?1987/35/1/41/26317


Full Text

 INTRODUCTION



Haemolacria is undoubtedly one of the most alarming and unusual complaints- in ophthalmology. This rare clinical phenomenon has been attributed to a variety of causes which have been adequately reviewed by Banta and Seltzer [1].Recently there have been case reports of haemolacria secondary to orbital varix [2]sub and giant papillary conjunctivitis. We report an interesting case of 'Bloody Tears' in a hysterical young female.

 CASE REPORT



This 15 years old girl was admitted to our hospital on the 22nd of November 1984 for investigations of bloody tears. These were first observed when the patient was under the stress of house examinations. The parents of the patient were startled when they saw bloody tears trickling over her cheeks while she was concentrating on her books. It was accompanied by headache and giddiness and the vision was unaffected. A day before her admission, bloody tears were seen for the second time. The third attack documented in the form of a photograph [Figure 1] was observed by the authors during the hospital stay of the patient and was conspicuous by the attention seeking behaviour of the patient. So far she has had eleven such episodes and no relationship with menstruation could be established in any of these. History of bleeding, disorders in the family was also denied. The blood was confirmed microscopically in the collected samples of tears and was of the same blood group as that of patient (B Positive).

On examination, lids, conjunctiva inclusive of fornices, palpebral part of lacrimal gland and lacrimal sac area were normal. Anterior and posterior segments did not reveal any abnormality. Vision was 6/6 both eyes. Gynaecological, ENT, and medical check-ups were ­within normal limits. Consulting Psychiatrist confirmed hysterical traits in the patient.

Complete haemogram, dacryocyst rhinogram and lacrimal gland biopsy were normal. Bleeding time, clotting time, prothrombin time index and platlet count were also within normal limits. The capillary fragility test was negative. Skiagrams of orbits, optic foramina and skull were without any abnormality.

Conservative treatment instituted in the form of reassurance to the patient, oral Vitamin C and K and injectable B Complex proved ineffective.

 DISCUSSION



Though a sanguineous discharge is relatively frequent in conditions of acute conjunctival hyperaemia and inflammation, occurrence of bleeding from conjunctiva as an isolated phenomenon is exceptionally rare. Duke Elder [4] outlined the differential diagnosis of bloody tears; severe anaemia, jaundice, vascular tumours, Osler-Weber-Rendu disease (hereditary haemorrhagic telangiectasia) haemophilia and other coagulopathies. Other causes reported are vicarious menstruation, conjunctival manipulation for follicle expression in trachoma, clinical treatment of conjunctiva with silver nitrate and epistaxis with retrograde blood stream into conjunctiva through puncta lacrimalia [5]. Recently Bona-volanta and Sammaritino [2] attributed orbital varix as a cause of bloody tears. In another interesting case Richard and Eifermam [3] blamed secondary giant papillary conjunctivitis for bloody tears.

In the present case of bloody tears we could not detect any organic cause for haemolacria after complete local and systemic examination and through investigations. The presence of hysterical traits as confirmed by the consulting psychiatrist led us to label hysteria as a possible case' of bloody tears in this case. Huss [6], Damalix [7], and Hynek [8] had also reported cases of haemolacria in patients of hysteria but the mechanism of production of bloody tears in these patients remain obscure, so far. However, Duke Elder [4] comments that in menstrual cases, it is the instability of the nervous system rather than hormonal disturbance, that is the cause.

References

1Banta, R.G., Seltzer,J.L., 1973, Amer. J. Ophthalmol. 75 : 726
2Bonavolanta, G., Sammaritino, A., 1981, Ophthalmologica. 182 : 5.
3Richard, A. and Eifermam, H.D., 1982, Amer. J. Ophthalmol. 93 : 524.
4Duke Elder, S., 1965, System of Ophthalmology. Vol. VIII, Pt. 1, 37. Henry Kimpton, London.
5Horn, 11.S., 1977, Acta Ophthalmol (Kbh) 55 : 132.
6Huss, 1857, Arch. Gen. Bled. 10 : 165. In System of Ophthalmology. Ed. Duke-­ Elder, 5., 1965, Vol. VIII, pt. 1, 39. Henry Kimpton, London.
7Damalix, 1882, Arch. Ophthalmol (Paris). 2 : 429 In System of Ophthalmology. Ed. Duke-Edler, s., 1965, Vol. VIII, Pt. 1, 39. Henry Kimpton, London.
8Hynek. Konnersreuth, London 1932.In System of Ophthalmology. Ed. Duke-Elder, 5., 1965, Vol. VIII, pt. 1, 39. Henry Kimpton, London.