Bleeding from the conjunctiva.

The discovery of frank bleeding from the conjunctiva, apart from injury, is a relatively rare condition, but it is not infrequent to find a sanguinous discharge in cases of severe inflammation of the conjunctiva. The various causes of bleeding from the conjunctiva are vicarious menstruation, haemophilia, anaemia, jaundice, vascular tumours, bleeding from the lacrimal gland, regurgitation of blood from the nose through the lacrimal passages, and hysteria. Spontaneous bleeding from the conjunctiva occurs in cases of vicarious menstruation, the weeping of "bloody tears" (lacrimae cruentae, dacryohaemuhysis: Duke-Elder, I965); this is mainly of historical interest, extragenital haemorrhages taking place at periodic intervals corresponding to the menstrual cycle (Novak and Jones, I96 i). Vicarious menstruation from the eyes was recorded very early by Dodonaeus (I58i) and Kersten (i841). Cases in which recurrent ocular haemorrhages can be correlated with menstrual somatic readjustment have been reported by Jungken (i842), Mackenzie (I854), Pascal (i888), Greig and Kynoch (I9I2), Gabrielid's (1923), Greig (I932), Poos (I933), Francois (I934), Dejean (I934), Toth (I944), and Polychronakos and Leanis (1956). Haemophilia has been described by various authors, where bleeding from the eyes was initiated by a slight trauma, and was even fatal (Schmidt-Rimpler, I887). Death from haemorrhage also followed the application of silver nitrate to the conjunctiva in the newborn (Miller, I893; Abbe, I899; Hansell, I900; Wiener, I903; Heal, 1928). Other cases of alarming conjunctival bleeding were recorded in anaemic patients by Fischer (I 832) and Cross (i 89 I) and in a jaundiced patient by Havers (1964) . The presence of vascular tumours in the conjunctiva has been found to be a cause of conjunctival haemorrhage. Jessop (I895) recorded a patient in a state of collapse due to haemorrhage from an ulcerated angioma in the upper lid. Other cases have been reported by Mathieu (I894), de Micas (I908), Wallis (I9I6), James and Trevor (I9I8), Maxted (I 9 I 9), White (I 945), Bakker (I 948), Ash (I 950), and Nirankari and Singh (i 96 I). Conjunctival haemorrhage may arise in certain cases from the lacrimal gland (Lindemann, I 920), and from regurgitation of blood from the nose, through the lacrimal passages, issuing usually through the inferior punctum (Duke-Elder, 1965). It has been noted in epistaxis, either spontaneously (Jongkees, 194 I), after nasal tamponage (Konikow, 19 I 6; Messner, 1947), or after a nasal fracture (Valiere-Valeix, I939; Urbantschitsch, 1946). The condition has also been seen in cases of hysteria (Huss, I857; Damalix, I882; Hynek, 1932,) and after gross disturbances of the autonomic nervous system (Bolotte and Fribourg-Blanc, I 93 I) . Conjunctival haemorrhage may also occur in healthy persons, with little or no cause apart from stooping (Perlia, i 888; Cross, I89I ) or muscular effort (Denti, I883); Minchin (I935) reported it in a child after copious weeping.