Haemolacria in a 22-year-old boy: BMJ case report
A 22-year-old boy presented with two episodes of spontaneous blood in tears. A detailed history and clinical examination was normal. Examination of the orbits was normal. An in-depth psychosocial analysis was not contributory. Blood tests including a complete haemogram, liver function tests and bleeding profile were normal. Bleeding time, clotting time, prothrombin time (PT) index and platelet count were also within normal limits.

The capillary fragility test was negative. PT was evaluated for von Willebrand disease. von Willebrand factor (vWF) antigen assay and the functionality of vWF with a glycoprotein Ib binding assay, collagen binding assay, ristocetin cofactor activity and ristocetin-induced platelet agglutination assays were normal.

Factor VIII levels are also checked and were found to be normal. Blood tests for dengue, leptospirosis were negative. Conjunctival swab culture was normal. Dacryocyst rhinogram and lacrimal gland biopsy were normal. CT scan of the skull including the orbit and face was normal.

No cause could be attributed to haemolacria in this patient despite an extensive radiological and haematological workup, along with a normal clinical examination. Hence, it was presumed it to be an idiopathic form of haemolacria.

Learning points:-
• Haemolacria is a rare medical condition and needs to be investigated more to understand it better.

• Approximately 30% of the cases are reported as idiopathic.

• A multispecialty approach is needed for evaluation of haemolacria.

Read more here: https://casereports.bmj.com/content/11/1/e225151
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