Haemolacria Secondary to Ocular Endometriosis: A Rare Case Report and review of literature
Author: Fadi Hassanin
Base Hospital / Institution: University of Jeddah
ePoster presentation
Abstract ID: 25-306
Purpose
To report a rare case of haemolacria due to presumed ocular endometriosis, and to emphasize the diagnostic challenge and importance of correlating with systemic history.
Methods
A 39-year-old woman presented with recurrent unilateral bloody tears, typically occurring during her menstrual period, over six months. History included pelvic endometriosis. Ocular examination, including slit-lamp and lacrimal irrigation, was normal—no signs of conjunctivitis, mass lesions, or inflammation. Systemic workup was unremarkable, including CBC, coagulation profile, and liver/renal functions. Orbital and paranasal MRI showed no abnormalities. Pelvic MRI revealed active deep pelvic endometriosis. No evidence of ocular or nasolacrimal mass was identified.
Results
The temporal association with menstruation, absence of local pathology, and the presence of systemic endometriosis supported the diagnosis of vicarious ocular endometriosis. The patient was started on oral progesterone, and symptoms completely resolved over a nine-month follow-up. Surgical biopsy from the lacrimal apparatus was deferred due to a lack of clinical and radiological findings.
Conclusion
Ocular endometriosis and vicarious menstruation are extremely rare but important differential diagnoses for haemolacria in menstruating females. Only a few cases have been reported. It is essential to first rule out more common and serious causes, including trauma, neoplasia, vascular malformations, and hematologic disorders. A high index of suspicion, correlation with the menstrual cycle, and systemic history are key to diagnosis. This case underscores the need for a multidisciplinary approach and high clinical suspicion in similar presentations. Hormonal therapy can be effective and avoid unnecessary surgery in selected cases.
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