The sight of blood mixed with tears, medically known as Hemolacria or bloody epiphora, is understandably alarming. While the symptom can look dramatic, it is often a manifestation of an underlying issue that is minor and localized to the eye or tear drainage system. A thorough medical evaluation is necessary to determine the precise source, which can range from simple irritation to a more complex physical condition.
Common Localized Causes
The most frequent sources of bloody tears originate directly in the eye or its immediate surrounding structures, often involving the highly vascularized conjunctiva. Minor trauma, such as a poke, an abrasion from a foreign object, or aggressive eye rubbing, can rupture delicate capillaries on the eye’s surface, causing blood to mix with the tears. Recent eye surgery involving an incision or excision can also lead to temporary Hemolacria as the tissue heals.
Inflammatory conditions are another common localized trigger. Severe cases of conjunctivitis, or “pink eye,” sometimes cause enough capillary breakage to result in blood-stained tears. Infections within the tear drainage system, such as dacryoadenitis (inflammation of the lacrimal gland) or dacryocystitis (affecting the tear sac), can also lead to bleeding.
A blocked tear duct, known as nasolacrimal duct obstruction, increases pressure within the lacrimal sac, forcing blood from surrounding vessels to backflow through the tear puncta. In women of childbearing age, Hemolacria may occasionally be linked to hormonal fluctuations, a rare phenomenon termed vicarious menstruation. This cyclical bleeding coincides with the menstrual period and is thought to be due to the response of ocular blood vessels to changes in estrogen and progesterone levels.
Systemic and Uncommon Causes
When local causes are ruled out, bloody tears may indicate a systemic health condition, though these are significantly less common. Conditions affecting the body’s vascular integrity or clotting ability can manifest as Hemolacria. Individuals on anticoagulant therapy (blood thinners) or those with blood clotting disorders like hemophilia may experience bleeding from multiple sites, including the tear ducts.
Uncontrolled systemic hypertension, or high blood pressure, can put excessive strain on delicate blood vessels, potentially causing them to leak or rupture into the tear film. In some cases, blood from a severe nosebleed (epistaxis) can travel backward through the nasolacrimal duct and emerge from the tear puncta, a process called retrograde flow.
The presence of abnormal tissue growth, such as vascular malformations or tumors, represents a more serious but rare cause. Vascular lesions like hemangiomas near the eye, or cancerous growths (neoplasms) within the tear glands or lacrimal sac, can lead to persistent or recurrent bleeding.
Diagnosis and Resolution
Any instance of bloody tears should prompt a visit to an eye specialist (ophthalmologist). Immediate medical attention is necessary if the bleeding is heavy, persistent, or accompanied by severe symptoms like vision changes or following significant trauma. The diagnostic process begins with a detailed medical history, including recent injuries, medications, and systemic health conditions. The specialist will perform a comprehensive physical eye examination using a slit lamp to inspect the conjunctiva and the tear drainage openings (puncta).
To evaluate the tear drainage system, specialized procedures like probing and irrigation may be performed to check for blockages or sources of bleeding within the ducts. If a systemic cause is suspected, blood tests are ordered to analyze the patient’s clotting ability and check for underlying hematologic issues. For cases where a tumor or anatomical issue is possible, imaging studies like Computed Tomography (CT) scans or Magnetic Resonance Imaging (MRI) of the head and orbits are used to visualize the internal structures.
Treatment for Hemolacria is determined by the underlying cause identified during the workup. If the cause is a bacterial infection, antibiotics are prescribed, while a minor injury may only require observation. Blockages in the tear duct may be resolved with a simple surgical procedure. If a systemic disease is the source, managing that condition—such as stabilizing blood pressure or adjusting anticoagulant medication—is the definitive approach to resolving the bloody tears.