What is haemolacria?
Haemolacria is a rare condition in which a person has blood in their tears. Typically, it is a symptom of another condition, such as an infection, laceration, inflammation or the development of abnormal tissue.
Haemolacria is also referred to by several other names, including sanguineous tears, dacryohemorrhea and hematic epiphora. The first historical reference to a person crying blood was made by Greek medical writer Aëtius of Amida in the sixth century.
The red discharge associated with haemolacria is a combination of blood and tears. The blood can come from anywhere on the surface of the eye, tear system or surrounding structures. It typically appears unilaterally (only in one eye) and is self-limiting.
Although haemolacria typically resolves on its own, you should still be evaluated by a doctor because it can be associated with severe eye and systemic diseases.
Haemolacria is so rare that there are no statistics regarding its prevalence in a particular people group.
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Crying blood causes
There is a wide variety of conditions that can cause haemolacria. In some cases, it may be idiopathic, meaning the cause is unknown.
Trauma
A cut or break (rupture) in the conjunctiva can cause blood to mix with tears. The conjunctiva is a clear, protective layer on the inside of the eyelids and the outside of the sclera, or the white of the eye. It produces a layer of mucus that helps keep the eye lubricated.
Likewise, an injury to the edge of the eyelid or to the punctum may cause bloody tears. The puncta (plural for punctum) — small openings inside the eyelids near the nose — act as tear drainage holes.
Inflammation
Inflammation in the conjunctiva (conjunctivitis) or along the eyelid (blepharitis) can cause haemolacria. Inflammation is the body’s response to an injury or infection. It involves a rush of blood to the affected area that may result in swelling, soreness, heat, and a red or dark appearance.
If the inflammation is severe enough, the tissue may erode, allowing the blood to leak and mix with tears.
LEARN MORE about eye inflammation
Vascular lesions
Lesions, or areas of abnormal tissue, can develop throughout the body. This includes the vascular or circulatory system — the body’s network of blood vessels.
There are various lesions that can develop in the vascular system of the eyes, some of which are benign (non-cancerous) and others that may be malignant (cancerous).
Benign vascular lesions or conditions of the eye include:
- Hemangioma
- Lymphangioma
- Conjunctival papilloma (typically benign but can become malignant)
- Conjunctival telangiectasia
- Pyogenic granuloma
- Conjunctival varices
- Severely vascular papillae
- Giant papillary conjunctivitis
Malignant lesions of the eye include:
- Malignant melanoma of the conjunctiva
If any of these lesions bleed, it can result in haemolacria.
Vicarious menstruation
Vicarious menstruation occurs when endometrial tissue develops in areas outside of the uterus. This can include the eyelid, conjunctiva or retina. Ocular vicarious menstruation is typically bilateral, or present in both eyes. It is rare and typically occurs when a person is in their 20s or 30s.
Those who experience this phenomenon may note that the bleeding follows the same cycle as their monthly period. This is likely due to the hormones associated with menstruation. However, it has also been suggested that nervous system dysregulation, rather than hormones, may be the cause.
Hematologic diseases
Hematologic diseases are disorders involving the blood. Any condition that increases bleeding throughout the body can manifest as haemolacria. These include:
- Hemophilia
- Thrombocytopenic purpura
- Deficiency of clotting factors
Vascular disorders
Vascular disorders impact the blood vessels that deliver nutrients and oxygen to various parts of the body. If high blood pressure (hypertension) is also present, the vessels may hemorrhage, or break open, causing bleeding. The main vascular disorders associated with haemolacria are:
- Hereditary hemorrhagic telangiectasia (also called Osler Weber Rendu disease)
- Henoch-Schönlein purpura
- Gardner Diamond syndrome
- Conjunctival varicose vessels
Systemic conditions
Systemic conditions are those that affect the entire body, involving multiple body systems. Some systemic conditions that can cause haemolacria are:
- Anemia
- Jaundice
- Exanthematous fever
- Severe autonomic nervous system issues
Epistaxis
In some cases, epistaxis (nosebleeds) can lead to haemolacria. Epistaxis occurs when the nasal cavity is filled with blood. Typically, the puncta drain tears to the nasal cavity. However, if the pressure is high enough, blood from a nosebleed may be pushed up and through the puncta, resulting in bloody tears.
Medications
Certain medications — particularly those with blood thinning properties — can also trigger haemolacria, including:
- Aspirin
- Clopidogrel
- Heparin
- Warfarin
Topical ointments and other medications used in or around the eye may also increase the risk of haemolacria.
Haemolacria treatment
Treatment for haemolacria is typically aimed at the underlying cause. If the cause is unknown, the physician may recommend a waiting period to see if any new symptoms arise. If haemolacria does not resolve on its own, additional evaluation or treatment may be required.
Is crying blood dangerous?
While it may be a scary thing to experience, haemolacria itself is not usually dangerous. However, it can be a symptom of a serious condition. The main concern is to determine what is causing the bloody tears.
Cultural beliefs behind crying blood
Images and depictions of bloody tears are sprinkled across various cultures and religions throughout history. They’re often seen as a symbol of sorrow and suffering.
In the Iliad, Zeus weeps tears of blood after realizing he must allow his son Sarpedon to be killed on the battlefield. Though Zeus couldn’t save his son, he ensured that Sarpedon received full burial honors.
For centuries, many works of art have depicted the Mater Dolorosa, or Mother of Sorrows, which portrays Mary shedding tears over Jesus’s crucified body. In some depictions, she appears to be crying blood.
Crying blood has also been associated with stigmata. These are wounds that literally or figuratively mirror Jesus’s wounds from his crucifixion.
Recently, scientists discovered that Vlad III (Vlad the Impaler) may have experienced haemolacria. Vlad was part of Bram Stoker’s inspiration for the vampiric character of Dracula.
When to see an eye doctor
If you notice blood in your tears or in the tears of a loved one, seek medical attention. Although haemolacria is not dangerous on its own, it can be indicative of a serious underlying condition.
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