A Case of Bloody Tears While Menstruating

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Patient with bloody tears
Patient with bloody tears. Source: BMJ Case Reports 2021
  • A 25-year-old woman complained of bloody tears while menstruating.
  • Doctors diagnosed her with ocular vicarious menstruation, an extremely rare condition.
  • The patient responded well to treatment with oral contraceptive pills and was symptom-free at her 3 months follow-up.

A 25-year-old married woman presented to the emergency room at a hospital in Chandigarh, India with bloody tears. Upon questioning it was revealed that this was her second time crying red tears. The last episode had occurred one month prior; both episodes coincided with her menstrual cycle. Despite her shocking appearance, the patient was not in any discomfort or pain.

The patient underwent an array of ophthalmological and radiological investigations. However, all came back normal. Doctors did not identify any other bleeding site or found any bleeding abnormality. Moreover, she had no history of injury to the eye or a family history of the condition. After ruling out all other causes of bloody tears, doctors diagnosed the patient with ocular vicarious menstruation.

Hemoclaria – Bloody Tears

Vicarious menstruation is cyclical bleeding occurring during menstruation from extragenital organs. The most common site is the nose; however, bleeding can also occur from the lips, eyes, lungs, and stomach. According to study authors, hormonal changes during menstruation affect vascular permeability in these organs. Thus, resulting in bleeding. Endometriosis, the presence of endometrial tissue in extragenital organs, is also considered a factor in the development of vicarious menstruation. However, the exact mechanisms remain unclear.

Oestrogen and progesterone can increase permeability of capillaries resulting in hyperaemia, congestion and secondary bleeding from extrauterine tissue

Study authors

Hemoclaria, or bloody tears, is a rare condition. It can indicate an underlying disease such as melanoma or occur due to a tumour in the lacrimal apparatus. Most commonly, it occurs because of an injury to the eye. However, in this patient’s case, it was associated with menstruation.

Based on previous literature, doctors treated the patient with oral contraceptives containing a combination of estrogen and progesterone. At her 3-month follow-up, the patient reported no further episodes.

Reference:

Ghosh S, Tale S, Handa N, et al. Rare case of red tears: ocular vicarious menstruation. BMJ Case Reports CP 2021;14:e237294. http://dx.doi.org/10.1136/bcr-2020-237294

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