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- A young woman was experiencing bloody tears – an extremely rare condition – during her menstrual cycle
- Visiting the emergency room at a hospital in India, doctors diagnosed her with ocular vicarious menstruation
- The patient was treated with oral contraceptives which caused the bleeding to stop
Hormonal changes during a woman's menstrual cycle can lead to emotional outbreaks and tears – but in the case of an unfortunate Indian woman, it was tears of blood.
The 25-year-old’s case was recently described in a BMJ Case Report after she visited the emergency room at the Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India, with tears of blood coming from both eyes.
According to the doctors, it was her second episode in two months. The first time, a nosebleed accompanied her bloody tears.
Blood tears, medically known as haemolacria, is a rare medical condition that has several causes, they wrote.
“Drops of blood were seen to be coming out from both the eyes [but] there was no injury to the eye. It was not accompanied by headache or giddiness … There was no family history of such a condition. She lived happily with her family according to her husband,” the authors noted.
After rigorous testing to rule out any other potential conditions, and it was confirmed that her eyes were undamaged, she was diagnosed with ocular vicarious menstruation – “a rare and unusual clinical case”, which occurs when menstruation triggers cyclical bleeding outside the uterus, they said.
The doctors treated her with oral contraceptives, and after three months she experienced no further bleeding incidents.
Crying blood tears
“Bleeding tears is an alarming clinical entity,” the doctors explained, with almost 30% of cases identified as idiopathic (a disease with an unknown cause). It is commonly associated with a tumour, trauma, infection, or a common infection such as conjunctivitis.
Health24 reported on a separate case last year, where doctors described an 11-year-old Indian girl shedding spontaneous blood-tinged tears for a week. Her mother confessed to hospital staff that the phenomenon was “horrifying”. Her experience was ruled as idiopathic, and she underwent counselling.
Vicarious menstruation
According to the doctors, vicarious menstruation can take place between the third and fourth decades of life and is known to occur from various sources such as the nose, eyelid, retina, ears, lungs, and nipples.
Since the patient described in the report had bleeding that was periodical, coincided with her menstruation cycle, and came from both the eyes, it raised the suspicion of ocular (related to the eyes) vicarious menstrual bleeding.
Surgery rarely necessary
They pointed to previous studies which showed that certain types of eye tissue are known to be affected by hormonal changes. According to their report, the cornea's curve and thickness, for example, can vary "during different phases of menstrual period, pregnancy and lactation", which could explain why the patient’s menstruation triggered bleeding from her eyes.
Some doctors, however, believe that the cause of vicarious menstruation is not due to hormonal disturbances, but instability of the nervous system. On the positive side, blood tears due to vicarious menstruation responds well to medical treatment, such as oral contraceptives, and rarely requires surgery, they said.
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