What is your diagnosis???
A 52-year-old man presented to the emergency department with painless, bloody tears from both eyes. The bleeding had begun spontaneously approximately 2 hours earlier, had lasted a few minutes, and had recurred just before presentation. He was taking captopril for mild hypertension, and his blood pressure was normal. The clinical examination revealed slight conjunctival hyperemia without periorbital or palpebral edema. The patient had normal vision and extraocular movements. Which one of the following is NOT a cause of hemolacria? a) Hemangioma b) Infection c) Adverse reaction to systemic antibiotics d) Trauma to eye or surrounding structures e) Retrograde epistaxis source: nejm.org
There are reports of Hemolacria with Capillary Hemangiomas, Endometriosis, Pyogenic Granulomas, Traumatic adnexal lesions and even Retrograde Epistaxis. It is a very rare presentation which can also be due to telangiectasia, Nasal, paranasal and periorbital neoplasms, bleeding diathesis like Hemophilias. The answer is "C" adverse effect of Systemic Antibiotics.
Retrograde Epistaxis, or also called bloody tears. An increase in pressure within the nasal cavity during epistaxis—for example, by pinching or blowing the nose, can cause retrograde flow of blood through the system and thus lead to bloody tears emerging from the ipsilateral eye! Very unusual indeed !
