Causes of Bloody Tears or Haemolacria

Bleeding eye
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Can you imagine crying tears of blood? It may sound like a horror movie, but bloody tears are actually a real thing. Blood in the tears is a rare condition known as haemolacria. Tears of blood have been documented through the ages, usually carrying a negative connotation. In some cultures, having bloody tears was once thought to be associated with demon possession. Thankfully, most cases of haemolacria are benign and usually occur with a reasonable explanation. However, several conditions must be considered when making a diagnosis. Before examining possible causes, let’s review the anatomy of the nasolacrimal system, the system responsible for producing and eliminating tears.

Tear Production

The tear-producing nasolacrimal system is composed of several parts. The lacrimal gland is a large gland that secretes tears. It is located under the eyelid of the orbit. Its function is to deliver tears to the eye's surface. Normal, everyday tears are referred to as basal tears. Tears that are produced by emotion or when something is in the eye are called reflex tears. There are also tiny glands embedded in the eyelid that produce tears. Meibomian glands line the eyelid to secrete oil that helps to stabilize the tear film and prevent evaporation. The lacrimal system is mainly controlled by the parasympathetic system and somewhat by the sympathetic system.

Each eyelid normally has one punctum situated along its margin in the region of its nasal area. These puncta are small holes that are easily seen on the surface of the eyelid margin. Each punctum has a small tube, or canaliculus, that leads to the nasolacrimal sac. The nasolacrimal sac then becomes the nasolacrimal duct and opens into the inferior meatus (small opening) of the nose. There is normally a small valve that allows for tears to flow down into the nose but does not allow tears to flow back up through the ducts. The tears themselves supply a lubrication function to the eye, as well as help the eye to create an optically clear image. The tears also carry nutrients, electrolytes, natural antibiotics, and oxygen to the surface of the eye and the cornea—the clear, dome-like structure on the front part of the eye.

Causes 

The majority of tears that contain blood are caused by the following conditions:

  • Conjunctival injury: The conjunctiva is a clear tissue membrane that lies on top of the sclera, the white part of the eye. Within the conjunctiva is a meshwork of blood vessels. Sometimes infection, inflammation, or laceration can cause bleeding of the conjunctiva, since it is so blood-vessel rich. The blood simply seeps out and mixes with the tears, making it appear as if the person is making tears with blood in them.
  • Blood disorders: Blood disorders, including hemophilia, can cause excessive bleeding due to clotting problems. People suffering from hemophilia may bruise or bleed easily. This can show up in the eyes as bloody tears. Other conditions that require taking blood thinners can also cause people to have bloody tears. Medications such as aspirin or heparin can be culprits in these cases. Patients that have frequent bruising or bleeding should be evaluated by their internist or primary care physician.
  • Pyogenic granuloma: A pyogenic granuloma is a benign, highly vascularized tumor that may grow on the conjunctiva or in the lacrimal sac. The lacrimal sac is the common junction where the two tear drainage canals join together to drain the tears. A pyogenic granuloma can occur from an injury, bug bite, or acute inflammation. Pyogenic granulomas also occur commonly during pregnancy due to hormone changes in the body.
  • Nosebleed: Bleeding in the nasal cavity (nosebleed) is technically called epistaxis. As described before, the lacrimal system that produces and drains human tears is connected to the nasal cavity. As we blink, our eyelids exert a slight diagonal push toward the corner of the eye, where the puncta are located. The puncta are small holes in which the tears drain. The puncta drain into the lacrimal sac and then onto the lacrimal canal and into the nose. This system describes the reason why your nose gets congested when you cry. If you have a nosebleed and blow or pinch your nose, a reverse flow of blood can be pushed back up through the nasolacrimal system. This will cause blood to regurgitate back through the puncta and into the tears, making it appear that the tears are composed of blood.
  • Lacrimal sac malignancy: Malignant melanoma can occur anywhere in the body, including the lacrimal sac, lacrimal gland, and the conjunctiva. People suffering from melanoma in these areas can have bloody tears. Other malignancies of the lacrimal sac, lacrimal gland, or the conjunctiva can also produce bloody tears. These are very serious conditions that require prompt treatment.
  • Uncontrolled hypertension: Although rare, bloody tears have been documented in cases of untreated high blood pressure. In most cases, what occurs is a broken blood vessel in the conjunctiva or in the nasal tissue. Because blood pressure is high, bleeding can be excessive. However, once the high blood pressure is brought down with medication, the bloody tears will stop.
  • Hormonal causes: Studies have documented haemolacria during menstruation. The bleeding is most likely caused by hormonal changes. Usually, the blood in tears is found in smaller amounts and does not cause a significant inconvenience to the woman experiencing it.
  • Idiopathic cause: There have been several cases of someone who cries tears of blood with no explanation and no medical cause. In these cases, no serious disease or disorders have been found, and the condition appears to resolve with time. No scientific explanation has been discovered for this rare phenomenon.

A Word From Verywell

Blood in tears, medically known as haemolacria, is a rare condition. Although usually benign, you should see an eye doctor for an evaluation if you notice blood mixed with your tears. Most cases of bloody tears usually resolve as fast as they start, but in some cases, serious causes, such as uncontrolled hypertension, malignant melanoma, or injury are to blame.

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  1. Qin B, Chen S. Conjunctival injury. Atlas of Ocular Trauma. Springer, Singapore; 2019.

  2. Wollina U, Langner D, França K, Gianfaldoni S, Lotti T, Tchernev G. Pyogenic granuloma - a common benign vascular tumor with variable clinical presentation: new findings and treatment optionsOpen Access Maced J Med Sci. 2017;5(4):423–426. doi:10.3889/oamjms.2017.111

  3. Cleveland Clinic. Nosebleeds (epistaxis). Updated October 23, 2019

  4. El-Sawy T, Frank SJ, Hanna E, et al. Multidisciplinary management of lacrimal sac/nasolacrimal duct carcinomasOphthalmic Plast Reconstr Surg. 2013;29(6):454–457. doi:10.1097/IOP.0b013e31829f3a73

  5. Dillivan KM. Hemolacria in a patient with severe systemic diseases. Optom Vis Sci. 2013;90(6):e161-6. doi:10.1097/OPX.0b013e318294c172

  6. Beyazyıldız E, Özdamar Y, Beyazyıldız Ö, Yerli H. Idiopathic bilateral bloody tearingCase Rep Ophthalmol Med. 2015;2015:692382. doi:10.1155/2015/692382