Answer to the last #DiagnosticDilemma
Correct answer: C, Adverse reaction to systemic antibiotics

There have been no reports of hemolacria directly related to systemic antibiotic use.

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

In this patient, slit-lamp examination revealed hemangiomas on the inside of both eyelids. The patient had 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 reported no orbital, ocular, or nasal trauma and no history of bloody tears, epistaxis, gingival bleeding, or easy bruising.

He 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 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.

Major Takeaway:-
- 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.

Source: https://www.nejm.org/doi/full/10.1056/NEJMicm1805241
Dr. R●●y J●●●●●●●m and 5 others like this1 share
Like
Comment
Share
J●●●●n A●●●●●m
J●●●●n A●●●●●m General Medicine
Can u share the question
Nov 1, 2018Like
Dr. P●●●●i C●●●●●●l
Dr. P●●●●i C●●●●●●l Obstetrics and Gynaecology
Hi Dr. Justin, the #DiagnosticDilemma of the week was: https://www.plexusmd.com/md/post/diagnosticdilemma-what-is-your-take-on-this-case/42383 : #DiagnosticDilemma: What is your take on this case??  -
Nov 2, 2018Like