Cyclic Bleeding Over Eyes Associated with Cyclic Epistaxis and Bleeding from Ears in Pubertal Females . Suggested Lacrimal Endometriosis

Introduction and Objective: Bilateral bleeding found over healthy eyes, in healthy pubertal females, that is cyclic and concomitant with menses, is a very rare event. Rarer is its association with cyclic epistaxis and cyclic bleeding from ears and skin bleeding. We present a series of such cases and a trial to diagnose and manage them. Those cases remained undiagnosed for years. We also present literature review about different diagnosis and about similar cases. Cases Report: We report a case series of 6 eyes of 3 patients, with history of cyclic bleeding over eyes. It was associated with epistaxis in two patients, with bleeding from ears in one and skin bleeding in one patient. Ages of these girls at presentation to us were as follow: 12, 13 and 20 years old. All of them reported its incidence at 12-13 years age (onset of their puberty). Bleeding was cyclic and took place around the menses time. No systemic or local disorders were found to explain this bleeding. Bilateral dacryocystography, blood and clotting profiles and CT scan for skull and sinuses, all were unremarkable. Cases were followed up as follows. Case 1 for 7 years, Case 2 for 7 years and Case 3 for 1 year. Photographs for all cases are available. As a therapeutic test, all cases received an intramuscular injection of Triptorelin acetate (Decapeptyl CR®, Ipsen) at the first day of their menstrual cycle. Bleeding stopped in all subjects from all sites. Discussion: This report shows 3 cases with multiple site cyclic bleeding concomitant with menstrual cycle. Bleeding occurred over eyes, from nose, from ear and at skin. After gynecological consultation and injecting Decapeptyl as a therapeutic test, bleeding stopped in all cases. This gives a clue about suggested lacrimal endometriosis. Some reports Correspondence: Dr. Osama M.M Al Nahrawy, 12 Al Nile Street, Ismailia, Egypt, e-mail: onahrawy@gmail.com, onahrawy@yahoo.com about similar cases are included. Decapeptyl is a gonadorelin (synthetic luteinizing hormone releasing hormone (LHRH) analogue. It acts on the pituitary gland in the brain and lowers estrogen levels in the blood. Conclusion: In view of the cyclic occurrence of bleeding over eyes that was associated with epistaxis and bleeding from ears, and its association with each menstrual cycle and the disappearance from all these sites after Triptoreline (Decapeptyl CR®) injection, the diagnosis of lacrimal endometriosis could be the most likely one.