A 43-year-old woman with nontraumatic profuse ocular hemorrhage

Abstract

A 43-year-old white woman presented emergently with sudden-onset, extensive bleeding from the left eye of one day’s duration, without pain, visual disturbance, trauma, or systemic symptoms. She had no significant ophthalmic, medical, surgical, or social history and did not wear contact lenses. Initial emergency department assessment revealed no eyelid laceration, penetrating injury, or identifiable source of bleeding. On same-day ophthalmic examination, her best-corrected visual acuity was 6/6 in both eyes, and pupillary responses were normal, without a relative afferent pupillary defect. Examination of the right eye was unremarkable. The left eye showed mild conjunctival hyperemia, a clear cornea, a deep and quiet anterior chamber, and a localized vascularized lesion on the superior lateral palpebral conjunctiva. Fundus examination was normal bilaterally. Initial investigations, including blood tests and orbital computed tomography, were normal. The lesion was suspected to be a pyogenic granuloma. Topical steroid–antibiotic treatment was unsuccessful. Excisional biopsy confirmed that the lesion was a benign vascular lesion composed of lobulated capillaries with inflammatory infiltrate and no malignant features, explaining the rare presentation of hemolacria.