A 15-year-old girl presented with a 1-month history of intermittent, bilateral ‘bloody tears’ (figure 1A, B). History revealed the symptoms began spontaneously 1 month back with an average one episode in 15 days lasting for less than a minute. Examination revealed 20/20 visual acuity in both the eyes with the normal eyelid, conjunctiva, lacrimal sac area, ocular surface, intraocular pressure and fundus. At the time of initial presentation, smear from the bloody tear film did not reveal any abnormal cells except for red blood cells, followed by lacrimal system syringing and probing revealed patent nasolacrimal system without any identifiable cause. Family history was negative for such symptoms/bleeding disorders, no history of any medication usage and of any disease/surgery related to periocular tissue, nose or sinuses. Haematological work-up showed normal complete blood count, bleeding time, clotting time, prothrombin time and liver function test. CT of the...
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