Hemolacria

dok_zlo — 26.01.2024

A 51-year-old man presented to the emergency department with a 1-hour history of bloody tears. Four hours before presentation, the patient had sustained blunt force trauma to the face in a fight. He had subsequently presented to the emergency department with nose pain and epistaxis and had received nasal packing. One hour after discharge from the emergency department, he returned with bloody tears, blurry vision, and eye pain. He had no history of ocular or nasal surgery. On physical examination, blood oozed from the upper and lower lacrimal puncta of both eyes (arrow; the right eye is shown) and accumulated along the margins of the lower eyelids — a finding known as hemolacria. The rest of the eye examination, including a slit-lamp examination, was normal. Ongoing epistaxis and ecchymosis of the nasal bridge were also noted. Computed tomography of the head and orbit showed no fractures. A diagnosis of hemolacria resulting from retrograde blood flow through the nasolacrimal system after nasal tamponade for epistaxis was made. To treat the ongoing epistaxis, the nose was repacked and topical epinephrine was applied to the left nasal cavity. A half hour later, the bloody tears had resolved. January 25, 2024 N Engl J Med 2024; 390:e8 DOI: 10.1056/NEJMicm2307811 Tao Zhang, M.D. Yong Tao, M.D. Beijing Chao-Yang Hospital of Capital Medical University, Beijing, China

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