Bloody tears: Ocular pyogenic granuloma inducing hemolacria during pregnancy.

Hemolacria, or bloody tears, is a symptom caused by several ocular disorders ranging from trauma to hormonal changes. We describe a case in which a 21-year-old, 28-week pregnant patient presented to the emergency department (ED) following her second occurrence of nocturnal left eye bleeding in a week. During her examination in the ED, a small abrasion to the lateral edge of the upper left lid was noted. No other injuries, traumatic mechanisms, or relevant past medical history were noted. Due to her pregnancy, the nascent pyogenic granuloma responsible for her hemolacria was managed conservatively. Despite management, the pyogenic granuloma rapidly grew within a few weeks causing ocular irritation and conjunctival injection. Due to concerns about ocular irritation, inability to close the affected eyelid, and decreasing visual acuity, the pyogenic granuloma was removed surgically. This case highlights the difficulty in managing pregnant patients with ocular complaints who initially present to the ED. In this case, the patient's pregnancy complicated her initial treatment plan, requiring more conservative initial management strategies. While conservative first-line treatment options for pregnant patients are recommended, they should be paired with constant risk-benefit assessment for the patient and her fetus.