TEARS OF BLOOD!.. The Rare Case of Ocular Vicarious Menstruation

Oheneba Kwakye Omane

In a rare medical case that has befuddled doctors, a woman complained that she had been bleeding from her eyes. Yes, it sounds bloodcurdling, but it's true. The 25-year-old married woman went to the emergency medicine department at the Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh; after she experienced crying tears of blood. That was her second such episode. Interestingly, she wasn't in any pain or discomfort and told doctors that she experienced the same thing a month as well, which was associated with mild nasal bleeding but she did not seek medical attention.

Drops of blood were seen to be coming out from both eyes. There was no injury to the eye. It was not accompanied by headache or giddiness. She did not use any local or systemic medication. There was no family history of such a condition. She used to live happily with her family according to her husband. At the time of presentation, she appeared medically stable. On examination by an ophthalmologist, her visual acuity was 6/6 in both the eyes, her eyelids, sclera, conjunctiva, lacrimal sac area, intraocular pressure and fundus were normal. There was no ocular swelling or congested vessels in the conjunctiva. There was no bleeding from any other site. There was no vascular lesion in the body. Gynaecological and Ear, Nose, Throat (ENT) evaluations were normal. Psychiatry evaluation revealed no mental illness.

She even underwent a vast array of tests to ascertain the root cause of her bleeding eyes, but all reports came normal. Neither were there any injuries to the eyes, nor she didn't have a family history of an ocular bleeding condition or any past issues with her eyes. So, what was causing it?

As the doctors examined the case further, they sensed a certain pattern. The doctors ultimately realized that both the times the woman cried tears of blood, she was on her periods. After ruling out all other probable causes, doctors diagnosed her with ocular vicarious menstruation.

What is ocular vicarious menstruation?

Vicarious menstruation. an extremely rare condition, ocular vicarious menstruation is defined as "cyclical bleeding in extrauterine or extragenital organs during the normal menstrual period,'' according to Dunn. Bleeding is also known to occur from many sources like nose, conjunctiva, eyelid, retina, ears, intestine, lungs, nipples and even skin but most commonly nose. In the patient, the fact that ocular bleeding was periodical, used to occur only during menstruation from both the eyes raised the suspicion of vicarious menstrual bleeding. Also, after hormonal treatment, there was no recurrence of such episodes. Despite extensive clinical, laboratory and radiological evaluation, no other alternative cause was found.

After the woman was diagnosed with it, her case was highlighted in the Journal (Am J Obstet Gynecol), wherein authors have explained how hormonal changes during menstruation affect 'vascular permeability in these organs, resulting in bleeding.

''Vicarious menstruation is considered to be due to response of vasculature (the anatomy of the vascular system of a part of the body and its arrangement) to the hormones in the presence or absence of endometrial tissue at extrauterine sites, although its exact pathophysiology (the disordered physiological processes associated with disease or injury) is not very clear. Oestrogen and progesterone can increase the permeability of capillaries resulting in hyperaemia, congestion and secondary bleeding from extrauterine tissue,'' the study notes.


The woman was treated with oral contraceptives containing a combination of estrogen and progesterone. After a three-month follow-up, the patient said she didn’t have any other episodes of bloody tears.

To further grasp and understand this medical phenomenon, we need to look at what ‘haemolacria’ is…

What is Haemolacria?

Crying bloody tears may seem like a fictional occurrence, but tears tinged with blood are an actual medical condition. Referred to as haemolacria, crying bloody tears is a rare condition that causes a person to produce tears tinged with, or partially made of, blood. In many cases, haemolacria is a symptom of another condition and is usually benign. However, if you begin to experience any instance of blood mixed with your tears, recurrent cases, or accompanying symptoms, seek immediate medical attention.

Haemolacria is an extremely rare condition and extensive evaluation is needed to exactly identify the cause of blood in tears. In some cases, a multidisciplinary discussion is needed to establish a confident diagnosis. Various aetiologies (causes of a disease or condition) like trauma, bleeding disorders, infections, ocular endometriosis, medications and lastly psychiatric disorders should be considered in the differential diagnosis. Relevant clinical history, examination and investigations should be done to establish the correct diagnosis.

What causes bloody tears?

Cases of haemolacria have been attributed to several causes and conditions. Some of the more common include:

  • inflammation conjunctival injuries trauma
  • blocked tear duct high blood pressure
  • blood disorders, such as haemophilia nosebleeds
  • pyogenic granuloma melanoma
  • tumours
  • hormone changes menstruation

In some cases of haemolacria, there are no identifiable medical causes or explanations. As a result, it may be deemed a spontaneous symptom that usually resolves in time.

Haemolacria is usually fleeting, ending as quickly as it started. But if you begin to experience additional symptoms with bloody tears, schedule an appointment with your doctor or health care provider.

Treatment for haemolacria

Before recommending treatment, your doctor will have to fully diagnose the underlying condition. To properly diagnose haemolacria, doctors may:

  • probe and irrigate the affected area of your eye
  • take cultures to identify any abnormalities
  • perform a nasal endoscopy
  • perform a CT scan of your sinuses

Effective treatment ultimately depends on the underlying cause. Often, bloody tears require no treatment. Your doctor might suggest a wait-and-see approach, but in more serious cases, your doctor may recommend:

  • medication or antibiotic eye drops to fight off infection dilation and flushing for tear draining
  • stenting
  • surgery or reconstruction

Before deciding on a treatment plan, discuss options with your doctor. Surgery and other invasive procedures may only be required in more serious cases.


Haemolacria, though initially shocking, is often harmless and resolves quickly on its own. It’s also been seen as a symptom of other conditions or diseases. If you begin to experience additional symptoms, discomfort, or pain in addition to bloody tears, seek immediate medical attention.


Dunn JM. Vicarious menstruation. Am J Obstet Gynecol 1972;114:568–9

Duke-Elder (1965) S. System of ophthalmology. 5th edn. London: Henry Kimpton; Hynek. Konnersreuth, London, 1932.

Ghosh S, Tale S, Handa N, et al. (2021) BMJ Case Rep;14:e237294. doi:10.1136/bcr-2020-237294


Oheneba Kwakye Omane

Health Enthusiast and Futurist