Hemolacria in a patient with severe systemic diseases

Hemolacria is a rare phenomenon of bloody tears caused by various ocular and systemic conditions, as well as psychological, pharmacologic, and idiopathic etiologies. Hemolacria is typically a benign process; however, serious systemic associations can exist. It is predominantly unilateral and self-limiting, but because of limited literature, its prevalence and predilection toward a specific gender, race, or age is not known.

An 82-year-old Caucasian male presented for an emergent eye examination with an acute onset of hemolacria of the right eye (OD). Patient medical history was extensive with coronary artery disease, atrial fibrillation, lipidemia, insulin-dependent diabetes, uncontrolled hypertension, and untreated severe renal failure. Before the incident, patient medication included warfarin, 81 mg of aspirin, insulin, glipizide, and blood pressure regime with which the patient was noncompliant. The patient was forwarded to urgent care to address his stage 2 hypertension and referred for a medical evaluation, which included a complete blood count, an International Normalized Ratio, a prothrombin time, and a glycated hemoglobin.

Spontaneous resolution of the hemolacria occurred within 24 hr after evaluation and restoration of blood pressure to normal range. Before follow-up, the patient died because of kidney failure. After a review of pertinent laboratory results and literature, the etiology of this patient's hemolacria could be attributed to either uncontrolled hypertension, chronic renal failure, aggressive anticoagulant therapy, and/or diabetes. An extensive literature review of documented etiologies and management is included.