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Blood-stained tears—a red flag for malignancy?

Eye volume 37, pages 1711–1716 (2023)Cite this article

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Abstract

Background

Blood-stained tears can indicate occult malignancy of the lacrimal drainage apparatus. This study reviews data on patients presenting with blood in their tears and the underlying cause for this rare symptom.

Methods

Patients presenting with blood in their tears, identified over a 20-year period, were retrospectively collected from a single tertiary ophthalmic hospital’s database and analysed.

Results

51 patients were identified, the majority female (58%) with a mean age of 55 years. Most cases were unilateral (96%) with blood originating from the nasolacrimal drainage system in 53%. The most common diagnosis for blood-stained tears was a lacrimal sac mucocele (n = 16) followed by a conjunctival vascular lesion (n = 4). Three patients had systemic haematological disorders. The rate of malignancy was 8% (n = 4), with 2 patients having lacrimal sac transitional cell carcinomas, one with a lacrimal sac plasmacytoma and the other with chronic lymphocytic leukaemia and bilateral orbital infiltration (with bilateral bloody tears). One patient had a lacrimal sac inverted papilloma, a premalignant lesion. Four patients had benign papillomas (of the lacrimal sac, conjunctiva and caruncle).

Conclusion

Haemolacria was a red flag for malignancy in 8% of patients (and tumours in 18% of patients). A thorough clinical examination including lid eversion identified a conjunctival, caruncle, eyelid or canalicular cause in 27% of cases.

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Fig. 1: Dacryocystogram (DCG) imaging findings in patients with blood-stained tears.
Fig. 2: Computed Tomography (CT) findings in patients with blood-stained tears due to malignancy and pre-malignancy.
Fig. 3: Clinic examination with lid eversion identified.

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Data availability

The datasets generated and analysed during the current study are not publicly available due to patient confidentiality but are available from the corresponding author on reasonable request.

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Authors and Affiliations

  1. Adnexal Department, Moorfields Eye Hospital, London, UK

    Megha Kaushik, Daniel G. Ezra, David H. Verity, Jimmy Uddin & Hannah Timlin

  2. Department of Ophthalmology, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK

    Valerie Juniat

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Contributions

Conceived and/or designed the work that led to the submission, acquired data, and/or played an important role in interpreting the results—MK, VJ, DGE, DHV, JU, HT. Drafted or revised the paper—MK, VJ, DGE, DHV, JU, HT. Approved the final version—MK, VJ, DGE, DHV, JU, HT. Agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved—MK, VJ, DGE, DHV, JU, HT. As corresponding author, MK, confirms that she has had full access to the data in the study and final responsibility for the decision to submit for publication.

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Correspondence to Megha Kaushik.

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Kaushik, M., Juniat, V., Ezra, D.G. et al. Blood-stained tears—a red flag for malignancy?. Eye 37, 1711–1716 (2023). https://doi.org/10.1038/s41433-022-02224-x

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