[Diagnostic value of occult haemolacria]. / Diagnosticheskaya znachimost' latentnoi gemolakrii.

PURPOSE: To study tears for occult (latent) haemolacria in women and compare the representativeness of the main methods of tear examination. MATERIAL AND METHODS: Tear samples from 72 women aged between 18 and 46 years were evaluated using two methods: microscopic and chemical with reagent test strips. RESULTS: In the follicular phase of the menstrual cycle, erythrocytes in tears were detected in 59.1% (13) subjects, which was significantly higher (χ2=4.2, p=0.041) compared to the luteal phase - erythrocytes were detected in 40.9% (9) women. The proportion of women in the luteal phase of the cycle who had single epithelial cells in the tear (76.9%) was significantly lower (χ2=5.2, p=0.022) than in women in the follicular phase (83.9%). The predictive value of the chemical method was 0.53 of that of the microscopic one. Microscopically, blood was detected in 30.6% of tear samples, while chemically - in 16.7%. An associative relationship was found between occult haemolacria in women and a diagnosis of endometriosis (K=0.75, p≤0.05). The proportion of women with erythrocytes in tears determined with the chemical method was 41.7% in patients with endometriosis, which was significantly higher (χ2=6.5, p=0.011) than 11.7% in women without endometriosis. CONCLUSION: Fluctuations of hormones during the menstrual cycle are reflected in tear composition, manifested as an increase in the number of epithelial cells in the luteal phase, and erythrocytes in the follicular phase. Erythrocytes found in a tear amid accumulations of epithelial cells, their glandular atypia and neutrophilic infiltration in patients with endometriosis may indicate the manifestation of extragenital endometriosis. The microscopic method turned out to be more sensitive in detecting occult haemolacria, and additionally it provided information about other cells. At the same time, the chemical method, which was relatively diagnostically informative, faster and technically simpler, can be used for screening.

[Haemolacria: etiopathogenesis, diagnosis, treatment]. / Gemolakriya: etiopatogenez, diagnostika, lechenie.

This article is devoted to the problem of haemolacria, which is a condition that causes a person to produce tears containing blood. The article generalizes and analyzes the data on this rare pathology from scientific literature, systematizes the information about etiopathogenesis of haemolacria and its clinical manifestations, describes possible diagnostic and treatment options, and presents the points of view of authors on this disease. The main purpose of this review is to inform about this rare pathology, which a doctor of any specialty has a chance to encounter.

Sudden-onset haemolacria in an adolescent girl.

Haemolacria, also known as bloody tears, is a physical condition in which a person produces tears partially composed of blood. Multiple disorders can cause haemolacria, including trauma, inflammation, vascular lesions, vicarious menstruation, blood disorders, epistaxis, tumours and psychiatric and systemic disorders. Often, no aetiology is identified. It is usually benign, self-limiting, and the treatment depends on the cause. A 14-year-old girl presented to the paediatric emergency department with sudden onset of bloody tears from both eyes and epistaxis for the first time. A detailed history focusing on aetiological factors was unremarkable. Systemic, ocular, nasal and paranasal examination was also unremarkable. Radiological and laboratory investigations were normal, and the patient was diagnosed with idiopathic haemolacria. High-dose oral vitamin C, prophylactic iron therapy and psychological support were provided as conservative treatment. During regular follow-up, there was a spontaneous reduction in the frequency of symptoms.

Factitious disorder, presenting haemolacria in a Pakistani tribal illiterate female: A rare case report.

INTRODUCTION: It could be challenging for healthcare workers to diagnose patients with factitious disorder who present with rare ophthalmologic manifestations such as haemolacria, because of the unavailability of adequate literature and associated guidelines. The present case report aims to fulfill this knowledge gap. CASE PRESENTATION: A 20-year-old tribal illiterate married female patient with symptoms of bleeding episodes from her left eye was admitted to the hospital. An extensive workup was done for diagnosing possible bleeding disorders but all the parameters were normal. Later on, she was diagnosed with factitious disorder presenting haemolacria after sufficient evidence at the psychiatric unit observations. The patient was treated accordingly, counseled and discharged, but lost-out to follow-ups. PRACTICAL IMPLICATIONS: The present case is reported from a developing country, Pakistan, for the first-time may help in diagnosing patients suffering from factitious disorder with unusual ophthalmologic problems.

[Bloody tears: About a case and a review of the literature]. / Quel bilan devant une haemolacria ? À propos d'un cas et revue de la littérature.

INTRODUCTION: Hemolacria is a rare hemorrhagic syndrome characterized by bloody tears. The most common etiologies are inflammation, infection or laceration. However, other rarer diseases may also cause this clinical manifestation. CASE REPORT: We describe the case of a 14-year-old male patient hospitalized for hemolacria. A history of von Willebrand disease was present in his family, diagnosed in his mother and sister, but absent in our patient. A vitamin C dosage was obtained in our patient and revealed scurvy consecutive to malnutrition. After having excluded other bleeding symptoms like bruises we retained vitamin C deficiency as the etiology of the hemorrhagic syndrome. CONCLUSION: Bloody tears are a rare clinical manifestation and the etiology may be difficult to determine. Bloody tears are a rare clinical manifestation of hemorrhagic syndrome. To determine the underlying etiology, screening should consider all possible causes including the rarest.

Síndrome de Gardner-Diamond. Presentación de un caso / Gardner-Diamond syndrome: A case report

RESUMEN El sindrome de Gardner- Diamond conocido también como púrpura psicógena o síndrome de autosensibilización eritrocitaria es muy poco frecuente. Se presenta el caso de un hombre de 50 años, blanco, ingresado en el Servicio de Medicina Interna del Hospital Clínico Quirúrgico Docente "Faustino Pérez Hernández" por síndrome febril agudo, cefalea holocraneana, epistaxis y hemolacria. En el examen físico realizado se notó la salida de lágrimas con sangre, por el ángulo interno de ambos ojos y epistaxis. La inyección intradérmica en la cara dorsal del muslo izquierdo de 0,1 mL de sangre autóloga, no indujo reacción equimótica. La inyección de 0,1 mL de solución salina al 0,9 % como control en el muslo contralateral resultó negativa. Sobre la base del examen clínico y otras pruebas, se concluyó como un Síndrome de Gardner-Diamond. Esta infrecuente enfermedad debe ser considerada en el diagnóstico diferencial de un síndrome purpúrico de etiología no bien precisada, fundamentalmente en pacientes con problemas psiquiátricos (AU).

ABSTRACT The Gardner-Diamond syndrome, also known as psychogenetic purpura or erythrocyte autosensitization syndrome is very few frequent. The case of a white patient aged 50 years is presented. He entered the Service of Internal Medicine of the Teaching Clinic-surgical Hospital "Faustino Pérez Hernández" because of an acute fever syndrome, holocraneal headache, epistaxis and haemolacria. At the physical examination it was stated the flow of tears with blood, through the internal angle of both eyes and epistaxis. The intradermal injection of 0.1 ml of autologous blood in the left thigh dorsal side did not induce an ecchymotic reaction. The injection of 0.1 ml of 0.9 % saline solution as control in the contralateral side was negative. On the basis of the clinical examination and other tests, the authors arrived to the conclusion it is a Gardner-Diamond syndrome. This infrequent disease should be considered in the differential diagnosis of a purpuric syndrome of non-good précised etiology, mainly in patients with psychiatric problems (AU).

Síndrome de Gardner-Diamond. Presentación de un caso / Gardner-Diamond syndrome: A case report

RESUMEN El sindrome de Gardner- Diamond conocido también como púrpura psicógena o síndrome de autosensibilización eritrocitaria es muy poco frecuente. Se presenta el caso de un hombre de 50 años, blanco, ingresado en el Servicio de Medicina Interna del Hospital Clínico Quirúrgico Docente "Faustino Pérez Hernández" por síndrome febril agudo, cefalea holocraneana, epistaxis y hemolacria. En el examen físico realizado se notó la salida de lágrimas con sangre, por el ángulo interno de ambos ojos y epistaxis. La inyección intradérmica en la cara dorsal del muslo izquierdo de 0,1 mL de sangre autóloga, no indujo reacción equimótica. La inyección de 0,1 mL de solución salina al 0,9 % como control en el muslo contralateral resultó negativa. Sobre la base del examen clínico y otras pruebas, se concluyó como un Síndrome de Gardner-Diamond. Esta infrecuente enfermedad debe ser considerada en el diagnóstico diferencial de un síndrome purpúrico de etiología no bien precisada, fundamentalmente en pacientes con problemas psiquiátricos.

ABSTRACT The Gardner-Diamond syndrome, also known as psychogenetic purpura or erythrocyte autosensitization syndrome is very few frequent. The case of a white patient aged 50 years is presented. He entered the Service of Internal Medicine of the Teaching Clinic-surgical Hospital "Faustino Pérez Hernández" because of an acute fever syndrome, holocraneal headache, epistaxis and haemolacria. At the physical examination it was stated the flow of tears with blood, through the internal angle of both eyes and epistaxis. The intradermal injection of 0.1 ml of autologous blood in the left thigh dorsal side did not induce an ecchymotic reaction. The injection of 0.1 ml of 0.9 % saline solution as control in the contralateral side was negative. On the basis of the clinical examination and other tests, the authors arrived to the conclusion it is a Gardner-Diamond syndrome. This infrequent disease should be considered in the differential diagnosis of a purpuric syndrome of non-good précised etiology, mainly in patients with psychiatric problems.

A healthy infant with bloody tears: Case report and mini-review of the literature.

A 4-month old healthy infant was brought by her parents to the emergency department with bloody tears of three days duration. There was also intermittent yellowish discharge since birth and a history of flu-like symptoms a week prior to presentation. Extensive investigations revealed no infection or other possible etiologies. The patient was treated with antibiotic eye drops and her condition resolved within a three-four days. In the literature, 15 cases with haemolacria of undermined source were reviewed; the median age of onset (12 years), bilateral involvement and female gender were more commonly encountered, and the most common associated illnesses were headache and epistaxis. The condition is self-limiting and spontaneous resolution is seen in majority of cases. Idiopathic haemolacria is a rare condition that can be presumed in patients presenting with bloody tears when all work-up turns to be negative. The condition is self-limiting with spontaneous resolution.

Un caso pediátrico de hemolacria / A pediatric case of haemolacria

Introducción: la presencia de lágrimas con sangre -o hemolacria- es un hecho infrecuente en la práctica clínica, y ha sido denominada con distintas acepciones en la literatura médica. Las causas que originan este signo son múltiples, y comprenden desde trastornos locales en el globo ocular, hasta enfermedades sistémicas, además de las provocadas en forma artificial y en otras. En ocasiones su etiología no se ha podido demostrar. Presentación del caso: adolescente, mestiza, de 16 años de edad que fue remitida al Hospital Docente Pediátrico del Cerro por el policlínico de su área de salud, porque presentó lágrimas con sangre con epistaxis acompañada de cefaleas y calambres en extremidades inferiores, además de referir un síndrome de inmunodeficiencia adquirida desde los 13 años. Durante su estadía hospitalaria se constató en dos ocasiones hemolacria con epistaxis. Los exámenes complementarios realizados para diagnosticar algún trastorno de la coagulación, enfermedad local o sistémica no transmisible, resultaron normales. Se indicó tratamiento con antirretrovirales para su afección de base. Se explicó la posible fisiopatología de este fenómeno. Conclusiones: la causa de esta entidad en la presente comunicación queda por precisar, y es el primer caso pediátrico reportado en Cuba(AU)

Introduction: the presence of tears with blood -or haemolacria- is an uncommon event in clinical practice which has been defined in several different manners in medical literature. The causes giving rise to this sign are many, ranging from local disorders in the eyeball to systemic diseases, alongside those brought about by artificial agents and others. On occasion it has not been possible to determine its etiology. Case presentation: a mulatto 16-year-old female adolescent was referred by the polyclinic in her health area to the Pediatric University Hospital in the municipality of Cerro with bloody tears and epistaxis accompanied by headaches and cramp in her lower limbs. The patient stated she had suffered from an acquired immunodeficiency syndrome since the age of 13. During her stay in hospital two episodes of haemolacria with epistaxis could be observed. The complementary tests performed to diagnose some other coagulation disorder, local condition or non-communicable systemic disease were all normal. Treatment with antiretrovirals was indicated for her underlying disease. The possible physiopathology of the phenomenon was explained. Conclusions: the cause of the condition discussed in the present communication is still to be determined. This is the first pediatric case of haemolacria reported in Cuba(AU)

Un caso pediátrico de hemolacria / A pediatric case of haemolacria

Introducción: la presencia de lágrimas con sangre -o hemolacria- es un hecho infrecuente en la práctica clínica, y ha sido denominada con distintas acepciones en la literatura médica. Las causas que originan este signo son múltiples, y comprenden desde trastornos locales en el globo ocular, hasta enfermedades sistémicas, además de las provocadas en forma artificial y en otras. En ocasiones su etiología no se ha podido demostrar. Presentación del caso: adolescente, mestiza, de 16 años de edad que fue remitida al Hospital Docente Pediátrico del Cerro por el policlínico de su área de salud, porque presentó lágrimas con sangre con epistaxis acompañada de cefaleas y calambres en extremidades inferiores, además de referir un síndrome de inmunodeficiencia adquirida desde los 13 años. Durante su estadía hospitalaria se constató en dos ocasiones hemolacria con epistaxis. Los exámenes complementarios realizados para diagnosticar algún trastorno de la coagulación, enfermedad local o sistémica no transmisible, resultaron normales. Se indicó tratamiento con antirretrovirales para su afección de base. Se explicó la posible fisiopatología de este fenómeno. Conclusiones: la causa de esta entidad en la presente comunicación queda por precisar, y es el primer caso pediátrico reportado en Cuba(AU)

Introduction: the presence of tears with blood -or haemolacria- is an uncommon event in clinical practice which has been defined in several different manners in medical literature. The causes giving rise to this sign are many, ranging from local disorders in the eyeball to systemic diseases, alongside those brought about by artificial agents and others. On occasion it has not been possible to determine its etiology. Case presentation: a mulatto 16-year-old female adolescent was referred by the polyclinic in her health area to the Pediatric University Hospital in the municipality of Cerro with bloody tears and epistaxis accompanied by headaches and cramp in her lower limbs. The patient stated she had suffered from an acquired immunodeficiency syndrome since the age of 13. During her stay in hospital two episodes of haemolacria with epistaxis could be observed. The complementary tests performed to diagnose some other coagulation disorder, local condition or non-communicable systemic disease were all normal. Treatment with antiretrovirals was indicated for her underlying disease. The possible physiopathology of the phenomenon was explained. Conclusions: the cause of the condition discussed in the present communication is still to be determined. This is the first pediatric case of haemolacria reported in Cuba(AU)

Haemolacria: A Novel Approach to Lesion Localization.

PURPOSE: To report the use of punctal plugs as a new modality to assist in the localization of lesions providing symptomatic relief in patients with haemolacria during their workup. METHODS: Retrospective case series. RESULTS: One boy and one girl, ages 16 and 20, respectively, reported spontaneous bloody tearing. Workup included probing and irrigation of the nasolacrimal system, blood and coagulation profiles, blood typing, serum hormone levels, conjunctival biopsy, and imaging. All findings were normal and failed to suggest a cause in any of the cases. Punctal plugs were inserted into each patient's inferior punctum OS without complication. On initial follow-up visits, each patient reported cessation of bloody tears OS with continued bloody tears OD. Over time, both patients experienced complete cessation of haemolacria in both eyes. CONCLUSIONS: Haemolacria is a condition caused by a group of disorders that result in the production of tears that are partially composed of blood. The large majority of cases result in a specific diagnosis. Only rarely does workup result in undetermined etiology. The novel approach of utilizing punctal plugs in the management of haemolacria may not only provide symptomatic relief for lesions distal to and including the punctum, but also assists in anatomic localization in idiopathic cases.

[Stigmata: From Saint-Francis of Assisi to idiopathic haematidrosis]. / Les stigmates: de Saint-François d'Assise à l'hématidrose idiopathique.

"Religious" stigmata describe body marks and sores that reflect the crucifixion wounds of Christ (hands and wrists, feet, flank, back, shoulders, forehead) and which are transferred to an individual through fervent prayer. "Non-religious" stigmata usually describe spontaneous episodes of bleeding with no identifiable cause outside any religious context. Irrespective of the setting in which they occur, such lesions are extremely striking. This review intends to summarize what is currently known about stigmata in the light of current medical knowledge, while stressing that the "spontaneous" nature of these lesions does not rule out a genuine medical cause.