Hemolacria in Children with Hematological Disorders: Case Reports

Background: Hemolacria, the presence of blood in tears, is an uncommon condition with various underlying etiologies. Although it can be alarming, its occurrence is often linked to a range of medical conditions, particularly in pediatric patients. Case Presentation: We present two pediatric cases involving hematological diseases who developed hemolacria as a manifestation of their underlying conditions. Case 1 includes that of an eight-year-old girl with chronic immune thrombocytopenia (ITP) who developed hemolacria during an episode of epistaxis. Case 2 is of a seven-year-old girl with acute lymphoblastic leukemia (ALL) who presented with hemolacria during maintenance chemotherapy. Both cases illustrate the importance of considering hematological disorders in the differential diagnosis of pediatric hemolacria. Both cases were managed using a multidisciplinary strategy tailored to their underlying conditions. Systemic treatments, including intravenous immunoglobulin, thrombopoietin receptor agonists, and chemotherapy, addressed the primary hematological disorders. Localized ocular therapies, such as artificial tears, topical steroids, and antihistamines, were employed to manage symptoms and prevent complications. Supportive care measures, including patient education and infection prevention protocols, were integral to both management plans. Conclusion: These two cases underscore the importance of recognizing hematological diseases as potential causes of hemolacria in children. Effective management requires a comprehensive, multidisciplinary approach that combines systemic treatment of the underlying disease with targeted local therapies and supportive care. Timely intervention is critical to ensuring favorable outcomes in these rare but significant presentations.