What is Hemolacria (Bloody Tears)?
Hemolacria, or bloody epiphora, is a condition where blood is present in your tears. This can also be referred to by several different names, including bloody tears, blood-stained tears, dacryohemorrhea, hematodacryorrhea, hemolacrimia, sanguineous tears, sanguineous lacrimation, hematic epiphora, dacryohemorrhysis, lacrimae cruentae, and tears of blood.
What Causes Hemolacria (Bloody Tears)?
When there’s blood in your tears, it may be coming from several parts of your eye or body:
The main source can be from the conjunctiva, which is a part of the eye that holds blood vessels. Sometimes, this part of the eye can bleed on its own or if you rub your eyes. Most of the time, though, the blood in tears that comes from the conjunctiva is caused by trauma, like injuries or surgeries involving the eye. However, it can also be due to inflammation, like severe conjunctivitis, which is an infection of the eye causing it to become red and swollen.
The conjunctiva can also bleed because of growths on it, such lesions that can be cancerous, or due to hormonal disruptions, particularly during menstruation. There’s a phenomenon known as vicarious menstruation where the eye may bleed in a cyclical manner similar to menstruation and this usually happens around the time a girl starts menstruating or around menopause. Foreign bodies, chemicals, or injuries to the lid can also cause the conjunctiva to bleed.
The lacrimal puncta, which are small openings located on the inner corner of your eyelids that allows tears to drain, can be another source of blood in tears. Sometimes, if there’s pressure in the nasal cavity due to a nosebleed or a packed nose following heavy nosebleed, blood can pass through the nasolacrimal duct and lacrimal sac (tear drainage system) and come out through the puncta.
Other possible sources of blood in tears are the tear glands, the orbit (eye socket), and from systematic diseases that cause increased bleeding risks such as hemophilia (a medical condition that impairs the body’s ability to make blood clots) and Purpura (a condition in which small blood vessels burst, causing blood to pool just under the skin).
In rare instances, the exact source of bleeding can’t be identified. There have been suggestions that when this happens, the blood could come from the glands that produce tears, but this is not certain. There are also a variety of other potential causes of bloody tears, including injuries to the head and medication side effects. Psychological factors like stress and anxiety can also cause bloody tears. When the cause cannot be determined, it’s said to be idiopathic.
Risk Factors and Frequency for Hemolacria (Bloody Tears)
Haemolacria is an extremely unusual condition. Because it occurs so rarely and there isn’t much research about it, we don’t know how often it happens, or if it affects a specific gender, race, or age group more commonly.
Signs and Symptoms of Hemolacria (Bloody Tears)
Hemolacria, or bleeding from the eyes, is typically not serious and it often goes away on its own. Still, because it can be linked with serious eye and overall health issues, it’s important that anyone experiencing this symptom be thoroughly evaluated.
Anyone who reports bleeding from the eyes should have a comprehensive eye exam, as well as a general health check to look for any possible causes of the bleeding. This check will include finding out if the person has any history of relevant health conditions (such as blood disorders, clotting problems, high blood pressure) or if they are taking certain medications (like warfarin, aspirin or clopidogrel).
If no eye or overall health causes can be found, the next step is to rule out any mental health related causes and a phenomenon known as ‘vicarious menstruation.’ Once all of these possibilities have been considered, if no cause can be identified, the condition may be labeled as ‘unknown’ or ‘idiopathic.’
Testing for Hemolacria (Bloody Tears)
When it comes to diagnosing why someone may have blood in their tears, both eye and full body examinations are necessary. If a doctor suspects the issue is related to the eyes, they may refer the individual to an eye specialist (ophthalmologist) for further testing. Besides this, doctors often suggest a special type of scan, called a computed tomography scan (or CT scan), of the head and orbits (the area around the eyes).
An uncommon technique that has been used to help diagnose the issue involves placing small devices, called punctal plugs, into the opening of the tear ducts. Doing so can help the doctor figure out whether the blood is coming from the tear ducts flowing back into the eye (what doctors call “retrograde flow”). If the blood in the tears goes away after these plugs are inserted but nosebleeds continue or start, this helps the doctor identify where the blood is actually coming from.
There is also a procedure called dacryoendoscopy that can be a helpful tool in figuring out if there are any bleeding sources within the tear drainage system. This is important because some sources might be missed without this type of examination.
Treatment Options for Hemolacria (Bloody Tears)
Haemolacria is a condition where a person has tears mixed with blood. Its treatment really depends on what’s causing it. For those cases where doctors can’t initially find a reason for the haemolacria, they would usually keep a close eye on the patient to rule out dishonesty or pretense, a practice known as ‘malingering’ in medical terms.
What else can Hemolacria (Bloody Tears) be?
When trying to identify the cause behind bloody tears, doctors could consider the following possibilities:
- Blood-colored tears in patients who are taking a medication called rifampicin.
- Occult haemolacria, where the tears appear to be clear, but microscopic or chemical tests show blood cells. This is actually pretty common, found in about 10% of the general population’s tears, and in 3% of the population, blood can also be detected through a chemical test known as the stix method. This is often seen in cases of acute infectious conjunctivitis and less frequently in chronic and subacute infectious conjunctivitis.
- False instances of bloody tears where individuals pretend their tears are bloodstained, using red liquids. Animal studies also have shown that rats treated with certain medications could secrete reddish-brown tears due to the secretion of specific types of compounds from certain glands.
- Black or dark-colored tears, known as Melanodacryorrhea, that can occur in circumstances like conjunctival argyrosis or with a type of eye condition called necrotic uveal melanoma.
What to expect with Hemolacria (Bloody Tears)
Heavy bleeding from tears can sometimes be life-threatening, particularly in patients with a condition called coagulopathy, which prevents blood from clotting properly. Because of this, it’s crucial to pinpoint if the cause of bleeding tears, also known as hemolacria, is related to an issue in the body’s system.
Possible Complications When Diagnosed with Hemolacria (Bloody Tears)
Crying blood, or haemolacria, does not typically cause further complications by itself. However, it can be a symptom of various health conditions, as described in the cause section. The most crucial step in managing haemolacria is to identify the root cause and direct the treatment towards it.
Preventing Hemolacria (Bloody Tears)
If the patient is taking blood-thinning medications due to certain health conditions, they might need to temporarily stop taking these drugs. They might be able to restart the medication at a lower dose later, but only after discussing this with both their eye doctor and their regular doctor. This is to ensure safety and effective treatment.
