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Brian T. Fowler, Alan E. Oester, James C. Fleming; Haemolacria: A Unique Diagnostic And Treatment Approach. Invest. Ophthalmol. Vis. Sci. 2011;52(14):1070.
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Haemolacria is a rare condition that causes a person to produce tears that are partially composed of blood. The condition has garnered significant attention in the medical community and media recently. Haemolacria is more accurately described as a symptom of multiple distinct entities most commonly involving the conjunctiva and lacrimal system. These entities can range from vascular malformations and tumors to infectious or inflammatory conditions and has even been reported in the literature as a presenting finding in scleral buckle infection. This report details two adolescent patients who presented to Hamilton Eye Institute with recurrent bilateral haemolacria and the utilization of punctal plugs for diagnostic lesion localization and treatment.
Two patients with otherwise unremarkable past medical history were referred to the oculoplastics clinic for the evaluation of recurrent bilateral haemolacria. Detailed ophthalmic examination and imaging revealed no cause for either patient’s "bloody tears." Thus it was suspected that the patients’ haemolacria was secondary to reflux of blood into the tears from a lesion located in the lacrimal apparatus distal to the puncta. A unique approach involving the placement of punctal plugs in the superior and inferior puncta in both eyes of each patient was utilized.
Punctal plugs were inserted into each patient’s superior and inferior puncta without complication. On follow-up visits, both patients reported cessation of bloody tears but continued nose bleeds. Most importantly, both patients reported a significant decrease in psychological stress and anxiety after inhibition of their "bloody tears."
Haemolacria is a group of disorders that result in the production of tears that are partially composed of blood. In most cases, the cause is determined on thorough ophthalmic examination and imaging. Only rarely does workup result in undetermined etiology. The idiopathic form most commonly occurs in children and adolescents and is well known to cause significant psychological stress. This novel approach of utilizing punctual plugs in the management of haemolacria not only provides a treatment but also allows for anatomic localization of the disease process in idiopathic cases.
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