The sight of blood mixed with tears is unsettling, a rare visual phenomenon medical professionals call hemolacria. Hemolacria is almost always a symptom of an underlying physical process, not a disease itself. Causes range from minor, self-resolving irritations localized to the eye to serious systemic conditions. Any instance of bloody tears warrants prompt evaluation by a healthcare provider to accurately determine the source and rule out a severe pathology.
Understanding Hemolacria
Hemolacria describes the presence of blood in the tear film, resulting in tears that appear pink, reddish-brown, or overtly bloody. The appearance varies depending on the concentration of red blood cells mixed with the normal tear fluid.
The lacrimal system produces and drains tears through a complex network that interacts closely with vascular tissue. Tears are produced primarily by the lacrimal gland and drain through small openings (puncta) on the inner corner of the eyelids, flowing through ducts into the nasal cavity. Bleeding can originate from any highly vascular structure near this system, such as the conjunctiva or the lining of the tear drainage ducts, before mixing with the tears.
Common Causes Originating Near the Eye
Many instances of bloody tears are caused by localized issues that are often transient. Minor trauma to the eye’s surface, such as forceful rubbing or a small foreign body, can rupture delicate blood vessels in the conjunctiva. This superficial bleeding quickly mixes with the tear film and resolves as the vessel heals.
Inflammatory conditions, like severe bacterial or viral conjunctivitis, can cause enough irritation and swelling to make conjunctival blood vessels fragile and prone to leakage. A localized infection of the tear drainage system, known as dacryocystitis, causes inflammation and swelling of the lacrimal sac. The resulting pressure or erosion can allow blood to backflow into the tear film through the puncta.
Bleeding can also be caused by the retrograde flow of blood from the nasal cavity through the nasolacrimal duct. This often occurs after a severe nosebleed (epistaxis), especially if the nose is forcefully blown, pushing blood backward into the tear drainage system. Rarely, hormonal fluctuations during menstruation can lead to vicarious menstruation, causing cyclical bleeding from vascular tissue around the eye.
Systemic Conditions and Serious Causes
While many cases are localized, hemolacria can signal a more serious, systemic problem. Disorders that affect the body’s ability to clot blood, known as coagulopathies, can manifest as bloody tears. These include conditions like hemophilia or thrombocytopenia, where the lack of proper clotting factors or platelets leads to spontaneous or excessive bleeding from small vessels throughout the body, including those around the eye.
Uncontrolled, severe hypertension can strain and damage the small blood vessels near the eyes, causing them to rupture and release blood into the tear film. Certain medications, particularly blood thinners like aspirin or warfarin, also increase the risk of bleeding from ocular structures. The presence of blood in these cases indicates the medication’s effect is pronounced.
Less commonly, the presence of blood can be a sign of a tumor or vascular lesion affecting the lacrimal apparatus or surrounding orbital structures. Malignancies of the lacrimal gland or lacrimal sac are rare, but their growth can erode adjacent blood vessels, leading to recurrent or persistent bloody tears. Vascular anomalies, such as hereditary hemorrhagic telangiectasia (HHT), cause abnormal, fragile blood vessels that can easily bleed into the tear drainage system.
Medical Investigation and Treatment
A medical investigation begins with a detailed patient history, focusing on the frequency, duration, associated symptoms, and a review of medications. A comprehensive eye examination, often using a specialized microscope called a slit lamp, allows the doctor to inspect the conjunctiva and tear drainage openings for a localized source of blood. The puncta may also be gently probed and irrigated to check for blockages or determine if the blood originates deeper within the nasolacrimal system.
Depending on the initial findings, the diagnostic process may escalate to imaging studies. A Computed Tomography (CT) scan or Magnetic Resonance Imaging (MRI) provides detailed views of the tear drainage system and surrounding orbital structures to identify tumors or fractures. If a systemic cause is suspected, blood tests are ordered to check for clotting disorders, platelet count abnormalities, or signs of inflammation.
Treatment depends entirely on the root cause identified during the investigation. For localized infections, a course of antibiotics or antiviral medication is prescribed to eliminate the source of inflammation and bleeding. If a tumor is detected, surgical removal is often necessary. When the cause is minor or unclear, a doctor may recommend careful observation, as many self-limited episodes resolve without specific medical intervention.