Hemolacria, the medical term for bloody tears, involves the discharge of tears mixed with blood. This rare phenomenon is a manifestation of an underlying issue, ranging from minor local irritation to a serious systemic health condition. The appearance of blood-tinged tears always requires a thorough medical evaluation, though the cause can sometimes be self-limiting and benign.
How Blood Enters the Tear System
The tear system is a delicate network rich in small blood vessels. Tears originate primarily in the lacrimal gland, flow across the eye’s surface, and drain through two tiny openings called the puncta. These puncta lead into the nasolacrimal duct, which empties into the nasal cavity.
Blood enters the tear film whenever a vessel ruptures or leaks along this path, mixing with the clear fluid. Contamination can occur at the lacrimal gland or on the eye’s surface. The conjunctiva, the thin membrane covering the white of the eye, is a common source because of its high concentration of tiny blood vessels.
Another pathway for blood contamination is a retrograde flow from the nasal cavity. If a severe nosebleed (epistaxis) creates enough pressure, the blood can be forced backward up the nasolacrimal duct. This blood travels up the tear drainage system and exits through the puncta, appearing to originate from the eye.
Causes Originating in the Eye or Tear Duct
Bloody tears are often caused by physical issues or infections directly affecting the eye and surrounding structures. Trauma to the eye or eyelid is a frequent cause, where a direct injury or a small foreign object can cause a tear in the highly vascular conjunctiva. Even minor friction, such as rubbing the eyes too vigorously, can sometimes rupture small capillaries.
Localized inflammatory conditions also lead to the appearance of bloody tears. Severe bacterial or viral conjunctivitis (“pink eye”) causes inflammation and swelling that can make the small blood vessels fragile and prone to leakage. Similarly, dacryoadenitis, inflammation of the lacrimal gland, can cause localized bleeding at the source of tear production.
Structural abnormalities or growths within the tear drainage system are another category of local causes. Benign vascular lesions, such as a pyogenic granuloma, are fragile growths that are easily irritated and bleed, contaminating the tears. Tumors or polyps within the lacrimal sac or nasolacrimal duct can obstruct tear flow and erode the lining, resulting in blood mixing with the tears as they drain.
Systemic Diseases and Other Internal Factors
In some instances, bloody tears are a manifestation of a health issue affecting the entire body, rather than just the eye. Conditions that affect the body’s ability to clot blood are a significant internal factor. Coagulation disorders like hemophilia or thrombocytopenic purpura can lead to spontaneous bleeding in various tissues, including those of the eye.
Certain medications, particularly aggressive anticoagulant therapies, can also increase the overall risk of bleeding. This lowered clotting ability makes the delicate vessels of the conjunctiva and tear duct system more susceptible to rupture from minor pressure changes or irritation. The resulting hemorrhage then mixes with the tear film.
Uncontrolled high blood pressure (hypertension) is another systemic condition linked to bloody tears. Severely elevated blood pressure can cause the rupture of small, fragile capillaries throughout the body, including those in the eye and nasal tissues. When a vessel breaks, the high pressure can contribute to a more significant bleed that mixes with the tears.
A rare but well-documented internal cause is hormonal fluctuation, often referred to as vicarious menstruation. Cyclical hormonal changes associated with the menstrual cycle can cause capillary bleeding in non-uterine tissues, including the conjunctiva or lacrimal system. This bleeding is typically minor and occurs predictably with the menstrual period.
When to Seek Medical Attention
Because bloody tears can signal a range of conditions, from a superficial eye injury to a serious systemic disease, professional medical evaluation is always recommended. A healthcare provider will typically begin with a thorough eye examination to look for local causes, such as visible lesions, trauma, or signs of infection in the conjunctiva or tear ducts. This initial evaluation often includes everting the eyelids to check for hidden growths.
If no obvious local cause is found, the investigation will broaden to look for internal factors. Diagnostic steps may include blood tests to check for clotting disorders, platelet counts, and other hematological anomalies. Imaging studies, such as a computed tomography (CT) scan of the orbits and sinuses, may be necessary to identify any tumors or structural issues within the lacrimal drainage system or the adjacent nasal cavity. Specific ophthalmological procedures, like dacryoendoscopy, may be used to visually inspect the inside of the tear drainage system for tiny bleeding sources. The focus of the evaluation is on accurately identifying the root cause, as treatment is entirely dependent on the underlying diagnosis. Even if the bloody tears resolve quickly, a medical assessment is important to rule out more concerning possibilities.