#DiagnosticDilemma: Whats your Answer?
A 52-year-old man presented to the emergency department with painless, bloody tears from both eyes. The bleeding had begun spontaneously approximately 2 hours earlier, had lasted a few minutes, and had recurred just before presentation. He was taking captopril for mild hypertension, and his blood pressure was normal. The clinical examination revealed slight conjunctival hyperemia without periorbital or palpebral edema. The patient had normal vision and extraocular movements. Which one of the following is NOT a cause of hemolacria?

1. Hemangioma
2. Infection
3. Adverse reaction to systemic antibiotics
4. Trauma to eye or surrounding structures
5. Retrograde epistaxis

Source: NEJM
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