It is not unusual to hear claims of religious statue usually Virgin Mary weeping bloody tear which attracted flocks of pilgrims or curious on-lookers. As often as not, these claims turned out to be hoax as the weeping Mary in Sacramento, California.
However, bloody tear in human being is certainly the most alarming and unusual complaint. Amongst the few reported cases almost all the sufferers were women, therefore, it is unusual for me to come across this boy who is reported to have shed bloody tear for the past 2 years sometimes lasting up to an hour. He is reported to have seen more than 15 eye specialists but no cause could be found.
The differential diagnosis of bloody tear is wide and includes severe anaemia, jaundice, vascular tumours, Osler-Weber-Rendu disease (hereditary haemorrhagic telangiectasia) haemophilia and other coagulopathies, tumours of the lacrimal sac, epitaxis. In this patient, the first line of investigation would be to make sure that the tear is indeed blood and the blood is of the same group as his to exclude a hoax. Detailed eye examination should be performed to look for any possible causes which I am sure his previous eye surgeons had performed. It would be interesting to hear what the final diagnosis is. His case is being made into a documentary and will appear in The Learning Channel.
Alarming bloody tear.
Blood coming down the face and nostrils suggesting that
the nasolacrimal ducts are not blocked.
The differential diagnosis of bloody tear is wide and includes severe anaemia, jaundice, vascular tumours, Osler-Weber-Rendu disease (hereditary haemorrhagic telangiectasia) haemophilia and other coagulopathies, tumours of the lacrimal sac, epitaxis. In this patient, the first line of investigation would be to make sure that the tear is indeed blood and the blood is of the same group as his to exclude a hoax. Detailed eye examination should be performed to look for any possible causes which I am sure his previous eye surgeons had performed. It would be interesting to hear what the final diagnosis is. His case is being made into a documentary and will appear in The Learning Channel.
Dear Dr. Chua Chung Nen,
ReplyDeleteFirst, I would like to say Thank you for all your hard work. I just entered my third year of medical school and am doing online research regarding artery disease and came across this site. I'm excited to read about this young man because I recall viewing his story on Murray (if my memory serves me right) when I was in high school. I remember the pain and hurt that his mother felt because she felt hopeless and couldn't find a physician who was able to help her son. I am happy to hear that today, this young man is under the care of a physician who's able to help him enjoy the qualitities of life without feeling embarrassed or different from the rest of the world.
Best of Luck,
Mary J.
Dear Dr. Chua Chung Nen,
ReplyDeleteI recently had a girl with extreme anemia due to menorrhagia. She bled 5 or 6 times including once at her school and once right in my clinic - suddenly. This time it was concurrent with her menses. She had been dubbed as a malingerer. I considered her to have an endometriosis. I did not know of some of the differential diagnoses you mentioned. Thanks.