NEJM reports case of eyelid hemangioma with bloody tears

Italy: An interesting case of eyelid hemangioma with bloody tears was reported in The New England Journal of Medicine. Alessandra Di Maria, from Humanitas Clinical and Research Center and Fausto Famà, University Hospital Messina, Italy describe the case of a 52-year-old man presented to the emergency department with painless, blood tears from both the eyes. The bleeding had begun spontaneously approximately 2 hours earlier, had lasted a few minutes, and had recurred just before presentation. He reported no orbital, ocular, or nasal trauma and no history of bloody tears, epistaxis, gingival bleeding, or easy bruising.

The patient was taking captopril for mild hypertension, and his blood pressure at examination was normal. The clinical examination revealed slight conjunctival hyperemia without periorbital or palpebral edema. The patient had normal vision and extraocular movements. The bloody appearance of the tears stopped spontaneously within 1 hour after the presentation. Slit-lamp examination revealed hemangiomas on the inside of both eyelids.

Hemolacria is a rare condition that is characterized by the presence of blood in the tears. Bleeding associated with tears can occur in the context of infection, inflammation, or trauma to the eye or surrounding structures, vascular tumors of the eye or surrounding structures, or retrograde epistaxis.

For the eyelid hemangiomas, the patient began using timolol ophthalmic drops. At 1 year of follow-up, the patient had had no further episodes of bloody tears.