Hemolacria due to possible idiopathic intracranial hypertension: A case report

Abstract

Background Hemolacria, the excretion of blood-tinged tears, merges biological oddity with mysticism. This report discusses a unique case of hemolacria in a patient with possible idiopathic intracranial hypertension without papilledema (IIHWOP), resolving after acetazolamide treatment, exploring a potential pathogenic link. Case Presentation A 50-year-old male experienced daily hemolacria for three months along with occasional epistaxis and otorrhagia. He also suffered from chronic migraine, often accompanied with blurred vision and vertigo, and primary stabbing headache. Systemic and neurological assessments, along with computed tomography (CT) brain scans, ophthalmological and hematological tests revealed no underlying diseases. Brain magnetic resonance imaging (MRI) along with magnetic resonance venography, indicated left transverse sinus aplasia, bilateral ocular bulb flattening and enlargement of optic nerve sheaths, suggesting increased intracranial pressure. The patient began acetazolamide treatment. In the next three months, he experienced only four bleeding episodes and a dramatic reduction of monthly migraine days. Discussion Our report first associates hemolacria with possible IIHWOP, proposing a new pathogenic pathway. A derangement in the glymphatic system, implicated in idiopathic intracranial hypertension pathophysiology, could explain its ocular symptoms, including hemolacria. Our findings may contribute to understanding IIHWOP and the glympathic system's role in ocular physiology.