What the neighbors say

Abstract

Di Maria et al. N. Engl. J. Med. 379:1766, 2018 In the list of bleeding symptoms included in most bleeding assessment tools, none of these BATs includes the symptom of weeping blood, a phenomenon reported in a recent graphic report by Di Maria et al. The case reported is a 52-year-old male who described spontaneous bloody tears from both eyes lasting for a few minutes, and then recurring. No orbital, ocular, or nasal trauma was reported, and there was no history of other significant bleeding problems. The clinical examination revealed slight conjunctival hyperemia without periorbital or palpebral edema and the patient had normal vision and extraocular movements. The bloody tears stopped spontaneously one hour after presentation. Slit-lamp examination showed hemangiomas on the inside of both eyelids. The presence of blood in the tears is referred to as hemolacria. Bleeding associated with tears can occur in association with infection, trauma to the eye, vascular tumors of the eye or surrounding structures, or retrograde epistaxis. There is no report of the association of hemolacria with systemic bleeding disorders.