Haemolacria: crying blood is real

Tears are made up of very important substances to lubricate the eye and allow adequate visual acuity. On very rare occasions may be accompanied by blood, which is known as haemolacria.

Despite its frequency, cases have been known for centuries. Most are caused by benign tumors, trauma, local infections, and hormonal changes. It is not usually considered serious, but it is advisable to see an ophthalmologist to determine the cause.

What is haemolacria and how does it occur?

This term refers to the emission of tears accompanied by blood. It has been known for many centuries, even having spiritual connotations because it is considered something related to the supernatural.

Even today it raises certain doubts in the general population, despite being a well-known syndrome by ophthalmologists. That does not mean that it is a rare condition.

In most cases these are self-limited episodes, which are even presented periodically. It does not usually produce associated symptoms and many people do not realize that they are bleeding until they touch the tears or look in a mirror.

Due to the communication of the lacrimal apparatus with the nasal cavity and then with the oral cavity, some patients may report a metallic taste while crying.

Possible causes of haemolacria

In this article we will only refer to the bleeding that accompanies the release of tears. This does not mean that the eyeball can present lesions in different places that, at one time or another, are susceptible to bleeding in another way.

Menstruation and hormonal problems

According to a study in the magazine Acta Ophtalmologica which included the participation of 125 people (men and women) to determine the presence of blood in the tears, many had no evidence of bleeding, so occult blood had to be determined by chemical methods.

In addition, the researchers conducted a special analysis on those women who were menstruating. 18% of women of childbearing age who were also menstruating turned out to have traces of blood mixed with tears.

But why is it linked to hormonal changes? When evaluating menopausal patients, none were positive for occult blood tests. In fact, of the men analyzed, only 8% had the phenomenon.

The hypothesis is that menstruation is a condition in which bleeding occurs through various orifices in the body. This includes the eyes, perhaps due to a subconjunctival hemorrhage. It usually occurs around menarche and, in rare cases, in connection with menopause.

Menstruation is associated with the presence of blood in tears due to the underlying hormonal changes.

Neoplasms

Benign neoplasms are a common cause of haemolacria. In the vast majority of cases the tumor cannot be seen, so the doctor will order imaging studies to see small lesions.

They usually appear along the lacrimal apparatus, especially in the duct or sac. The main benign tumors in the area are papillomas and hemangiomas. The former can have various causes, but the term refers to lesions that have external and bushy growth. In fact, they can come out almost anywhere on the body.

Hemangiomas are also quite common and are neoplasms of blood vessels. They usually appear isolated and on the skin, although in some cases they spread to internal organs. Pyogenic granuloma is another benign tumor that, if found in this atypical ocular location, is associated with the phenomenon.

Find out more: Infantile hemangiomas: what are they?

Hematological diseases

Sometimes, bleeding is the product of blood diseases in which coagulation is impaired. This process refers to all those natural measures to guarantee hemostasis.

Hemophilia is one of these characteristic diseases. It has several subtypes, which are A and B, when there is a deficiency of coagulation factors VIII and IX, respectively. It is often diagnosed in childhood, since apparently normal injuries (such as a fall in the park) can cause heavy bleeding.

A case of hemophilia (or another less common bleeding disorder) may cause haemolacria. Local infections (such as conjunctivitis), moderate-intensity trauma, and scratching are factors that can promote bleeding with tears.

Inflammation

The presence of inflammatory lesions can cause damage to small blood vessels. This is stated by an informative publication of the National Center for Biotechnology Information from United States. The relationship is established with severe cases of conjunctivitis in which there is ulcer formation.

This phenomenon produces the recruitment of cells of the immune system (such as macrophages, neutrophils and lymphocytes), which are responsible for producing local biochemical reactions in the presence of a foreign agent. According to some authors, haemolacria could be a manifestation of postoperative infections in the eyeballs.

Both surgeries and the presence of foreign materials within the body can produce inflammatory phenomena unwanted, which are sometimes treated with medication to avoid complications. Haemolacria is a sign that alerts ophthalmologists to possible postoperative complications, perhaps in relation to the development of fistulas.

Keep reading: Bacterial conjunctivitis: what is it?

Diagnosis and treatment of haemolacria

The personal interview and the eye physical examination are essential aspects during the medical consultation for haemolacria. However, except for external tumors or similar abnormalities, this evaluation may be fairly normal.

To detect internal anatomical defects, the doctor may request a computed tomography or nuclear magnetic resonance, in order to visualize small structures capable of producing bleeding.

In most cases, immediate treatment is not required. Thus, the doctor can opt for an expectant posture while waiting for the results of the examinations. If a cause is identified that needs to be resolved, surgery, anti-inflammatory drugs, or antibiotics may be used.

Ocular postoperative procedures may have haemolacria as a complication.

How common is it?

Haemolacria is very rare. Nowadays the distribution of the disease is unknown according to sex, race or age.

This is not to say that the possible causes mentioned at the beginning of the article are also rare. Hemophilia, papillomas, conjunctivitis, eye trauma, and ophthalmic surgeries are common. The detail is that they almost never produce bleeding through tears as an associated symptom.

The rare condition of the haemolacria is not always alarming

Haemolacria is a rare condition and should be considered as a symptom. The doctor specialized in its diagnosis and management is the ophthalmologist, who in few occasions could refer another professional to complete the study.

It is not a serious condition, unless the bleeding is heavy and has a significant impact on the patient's life. There are few cases associated with a malignant neoplasm in this location, but when in doubt it is advisable to plan a consultation.

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