Haemorrhage from the Lacrimal Punctum

Abstract

H\AEMORRHA\GE trlom the punctuni is exceedingly, rare, scant reference is made to it in the literature, but the following cases are on recor(l Konikow (1916) recorded a case of severe epistaxis, in which anterior and posterior tampons were inserted. A few minutes later "bloody tears " began to flow from the corresponding eye. Pressure on the nasal duct stopped the flow. Hird (1932) reported a case in a woman aged 39, of blood in the right eye for four days, with a swelling at the site of the right lacrimal sac. The patient stated that she used to get bleeding from the eye as a child, and that she had had a tumour removed five times in childhood, the last time when aged 13. There were some old scars in the lower lid, presumably the sites of the previous operations. A colleague reported the removal of a papillomatous growth from the right lower fornix and the application of electric cautery to some small papillomata on the conjunctival surface of both upper and lower lids. Pressure over the distended lacrimal sac caused a blood-stained discharge to escape from the punctum into the conjunctival sac, and on further pressure pure blood escaped. The following day the sac and contents were excised, and the pathologist confirmed the diagnosis of a simple papilloma of the lacrimal sac. Jongkees (1941) reported bleeding fromn the lacrimal duct during nasal haemorrhage. Messner (1947) reported his second observation of profuse ocular haemorrhage after tamponage of the nose for epistaxis. Spontaneous epistaxis occurred in a hypertensive woman aged 72, who treated it by packing the nose with cotton wool. Blood issued from the inferior lacrimal punctum of the left side. Tamponage of the nose with stryphon gauze, intravenous calcium injection, and clauden-coagulen injected intramuscularly stopped the haemorrhage. Thirty-six hours later the patient wxas in good condition. Urbantschitsch (1946) described a somewhat similar case, which occurred after a fracture of the nasal bone. Valiere-Vialeix (1947) miakes a similar observ ation.To these I ,x-ish to add the following case.A 78-X-ear-old publican, of rudldy comiiplexion, who had been accuistonmed to take more than a bottle otf wfhislsk al day for many vears, had intermitteint blee(ling from the left eve for seveni days, and had suffered ain alarming and profuse haemorrhage the previous night.Blood was seen escaping from the inferior laci-rimial punctum and trickling dox-n the cheek. No lesion of the eye or lids w7as present. There ,xas no swelling over the lacrimal sac nor was there any previcus history of epiphora.Digital pressure over the sac at first increased the flow of blood from the lower punctum but after a few minutes the bleeding stopped and did not recur. Some clotted blood in the left nostril was observed. The patient admitted to slight and negligible epistaxis, but was convinced that he had bled first and very much more profusely from the eye. X ray,s of the area revealed no pathology. The blood pressure was not raised.

Epistaxis-related hemolacria in a 6-year-old female after midfacial trauma: Epistaxis-related hemolacria

“…However, to date, only a few cases have been reported and none of the reported cases were associated with post-traumatic vessel injury. Abel reviewed these cases for the first time in 1950 [7], looking at all the cases reported between 1916 and 1947 and presenting a new case in detail. The clinical condition was not yet denoted as HL, instead expressed as "ocular hemorrhage," "bleeding from the eye," "hemorrhage from the lacrimal punctum," or "bleeding from the lacrimal duct."…”

“…For example, in the patient by Drake and Packer [8], HL developed after the insertion of a "Rhino Rocket" nasal tamponade device to treat persistent epistaxis. Epistaxis is idiopathic in some cases [9] or may be secondary to underlying conditions with systemic effects (e.g., end-stage renal disease, psychological stress, irritant exposure, and alcoholism) [7,8,10,11] and to maxillary orthognathic surgery [12]. The two patients by Humber et al, after having orthognathic surgical correction of Class III malocclusion, presented with complaints of epistaxis and retrograde hemorrhage from ipsilateral nasolacrimal puncta, one on the 8 th day postoperatively and the other early on after her transfer to the post-anesthesia care unit [12].…”

Occult haemolacria in females

“…Blood-stained tears have been observed in association with conjunctival haemorrhage in Schonlein-Henoch purpura (Siggers 1970), and electroshock therapy (Delord 1952). Furthermore, haemolacria has been seen in patients with congenital heart disease (Angelone 1949), posttraumatic epilepsy (Scott 1927), and retrograde epistaxis (Jongkees 1941;Abel 1950;Banta & Selzer 1973). Bloodstained tears have also been noticed in hysterics and in religious fanatics in the form of stigmatisation (Meyer & Kluth 1952).…”