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  • Ocular Pathology/Oncology, Oculoplastics/Orbit

    Review of: Blood-stained tears—a red flag for malignancy?

    Kaushik M, Juniat V, Ezra D, et al. Eye (London), June 2023

    Blood-stained tears may indicate occult malignancy of the lacrimal drainage apparatus, but only in a small number of instances.

    Study design

    This was a retrospective study over a 20-year period of 51 patients (mean age 55 years; 58% female) who presented with blood-stained tears (hemolacria). Exclusion criteria included age <16 years, anophthalmic sockets, viral conjunctivitis, and ophthalmic surgery or trauma within 2 years of presentation.


    Ninety-six percent of cases were unilateral. Hemolacria was positively confirmed in 25% of cases. Blood-stained tears originated from the nasolacrimal system in 53% of patients and from conjunctival lesions in 16%. Overall, 18% of patients were found to have tumors (malignant lesions and benign papillomas of the lacrimal sac, conjunctiva, and caruncle); 8% of patients had malignancies.


    Limitations of this study include a small sample size and the retrospective study design. In addition, there were patients who declined further investigation or did not follow up and therefore never received a diagnosis.

    Clinical significance

    Traditionally, blood-stained tears in an adult have been thought to be a harbinger for malignancy of the lacrimal sac. This study confirms that hemolacria is associated with malignancies, but only in 8% of patients. In patients presenting with these symptoms, it is important to perform a complete slit lamp examination and eversion of the eyelids. If no cause is detected with this, then lacrimal irrigation should be performed. Dacryocystography is a useful modality to detect lacrimal drainage issues such as retained foreign bodies, nasolacrimal duct obstruction, and lacrimal sac masses. Finally, laboratory investigations, including hemoglobin level, platelet count, and coagulation tests, can be performed to detect any hematologic disorders.

    Financial Disclosures: Dr. Richard Allen discloses no financial relationships.