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Correspondence to Dr Soumitra Ghosh; [email protected]
Background
Haemolacria is an extremely rare condition and extensive evaluation is needed to exactly identify the cause of blood in tears. In some cases, a multidisciplinary discussion is needed to establish a confident diagnosis. Various aetiologies like trauma, orbital varix, bleeding disorders, infections, ocular endometriosis, medications and lastly psychiatric disorders should be considered in the differential diagnosis. Relevant clinical history, examination and investigations should be done to establish the correct diagnosis. Cyclical bleeding in extragenital organs during the normal menstrual period is referred to as vicarious menstruation.1 In this article, we presented an interesting case of ‘bloody tears’, which used to occur periodically during menstruation in a young female. This is a rare and unusual clinical case. There is no such recent case reported in the literature. In order to understand its pathophysiology and management, more research is needed.
Case Presentation
A 25-year-old married woman came to emergency medicine department at Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh with crying red tears. That was her second such episode. First episode occurred 1 month prior to current episode, which was associated with mild nasal bleeding but she did not seek medical attention. On further enquiry, she revealed that during both the episodes, she was menstruating. Drops of blood were seen to be coming out from both the eyes (figure 1A,B). There was no injury to the eye. It was not accompanied by headache or giddiness. She did not use any local or systemic medication. There was no family history of such condition. She used to live happily with her family according to her husband. At presentation, she was haemodynamically stable. On examination by ophthalmologist, her visual acuity was 6/6 in both the eyes, her eyelids, sclera, conjunctiva, lacrimal sac area, intraocular pressure and fundus were normal. There was no ocular swelling or congested vessels in conjunctiva. Anterior and posterior segments were normal. There was no bleeding from any other site. There was no vascular lesion in the body. Systemic examination was normal. Gynaecological and Ear, Nose, Throat (ENT) evaluation were normal. Psychiatry evaluation revealed no mental illness.
Investigations
On investigations, complete haemogram, bleeding time, clotting time, prothrombin time index and platelet count were within normal limits....