Hematolacria, or bloody epiphora, is a rare medical phenomenon where tears are tinged or colored with blood. While visually alarming, hematolacria is a symptom of an underlying condition rather than a disease itself. The blood can originate from anywhere along the tear production and drainage system, including the lacrimal gland, the conjunctiva, the eyelids, or the nasolacrimal duct. Because the causes can range from minor localized issues to more serious systemic health problems, understanding the origin of the bleeding requires a careful medical evaluation.
What Are Bloody Tears (Hematolacria)?
Hematolacria refers to the condition where blood is present in the tear fluid, resulting in tears that appear red. The color can vary significantly, from a faint pink tint, indicating a small amount of blood mixed with tears, to a dark, thick crimson that appears to be entirely composed of blood. The source of this blood is usually a localized breach in the small blood vessels near the eye’s surface or within the tear-producing or draining structures.
This discharge may be accompanied by other symptoms that offer clues to the underlying cause. A person might experience a foreign body sensation in the eye, noticeable irritation, or localized swelling around the eyelids. Bloody tears may also be associated with blurred vision or discomfort, especially if the underlying cause involves significant inflammation or injury to the ocular surface.
Common Localized Causes
The most frequent reasons for bloody tears are typically confined to the eye and its immediate surrounding structures. Localized physical trauma is a primary cause, such as a direct impact to the eye, a severe abrasion, or the presence of a small foreign object. Even minor injuries, like aggressive eye rubbing, can rupture the fragile capillaries on the ocular surface, leading to blood-tinged tears.
Severe inflammation or infection of the eye can also trigger hematolacria due to increased vascular fragility. Conditions like acute hemorrhagic conjunctivitis involve intense inflammation that makes the small conjunctival blood vessels prone to bleeding. Similarly, a specific type of vascular lesion called a pyogenic granuloma, a rapidly growing, benign mass, may form on the conjunctiva and bleed spontaneously or with minimal contact.
Issues with the lacrimal drainage system, which connects the eye to the nasal cavity, can also be a source. If a person experiences a profuse nosebleed (epistaxis), the blood can sometimes be forced backward through the nasolacrimal duct and emerge from the tear duct opening (punctum) as bloody tears. Blockages or infections within the lacrimal sac or duct, such as dacryocystitis, can also cause local pressure and inflammation that results in blood being expelled with the tears.
A less common but recognized localized cause is vicarious menstruation. This phenomenon occurs when women experience cyclical bleeding from non-uterine sites, including the eye, around the time of their menstrual period. This is thought to be a response to hormonal fluctuations that affect the blood vessels in the eye and is typically a benign, self-limiting event.
Systemic and Rare Medical Triggers
While many cases of bloody tears are localized, physicians must also investigate more serious triggers that affect the entire body. Systemic blood clotting disorders are a significant concern, as any condition that impairs the body’s ability to form clots can lead to spontaneous bleeding. Examples include hemophilia or severe thrombocytopenia, where a low platelet count compromises the clotting process.
Certain medications can increase the propensity for bleeding and may manifest as bloody tears, especially in the presence of minor localized trauma. These include blood thinners like warfarin, aspirin, or clopidogrel. Uncontrolled, severe systemic hypertension can also be a factor, as extremely high blood pressure may cause fragile blood vessels in the conjunctiva or the nasolacrimal system to rupture.
Rarely, the cause may be related to abnormal growths or vascular anomalies. Tumors, whether benign or malignant, affecting the lacrimal gland, lacrimal sac, or conjunctiva can erode into blood vessels, resulting in chronic or recurrent bloody tears. Systemic vascular diseases, such as Hereditary Hemorrhagic Telangiectasia, cause abnormal blood vessel formation. This creates fragile vessels that are prone to hemorrhage anywhere in the body, including the tear system.
Diagnosis and Urgent Medical Consultation
Any instance of bloody tears warrants an immediate medical evaluation. A comprehensive examination begins with a detailed patient history, where the doctor will inquire about the frequency, duration, associated symptoms, recent trauma, or medication use. This is followed by a thorough eye examination, often using a slit lamp microscope, to pinpoint the exact source of the bleeding on the eye’s surface.
If the source is not immediately visible, the physician will perform specialized tests. These tests may include probing and irrigation of the tear ducts to check for blockages or retrograde flow from the nasal cavity. Imaging studies, such as a computed tomography (CT) scan of the orbits and sinuses, may be necessary to visualize the lacrimal drainage system and rule out tumors or structural anomalies. Blood tests, including a complete blood count and coagulation profile, are routinely performed to investigate potential systemic clotting disorders or underlying diseases.
Certain accompanying symptoms are considered immediate red flags that require emergency medical attention. These include a sudden loss of vision, severe, unrelenting eye pain, or any sign of a significant head or facial trauma preceding the hematolacria. Bleeding that is profuse or does not stop quickly, or bloody tears accompanied by new bruising or bleeding elsewhere in the body, also signals a systemic problem that must be addressed without delay.