Haemolacria, commonly known as Bloody Tears due to its striking physical manifestation, is a rare condition that often induces sudden panic and distress in both patients and healthcare providers. The limited literature on haemolacria, combined with its diverse aetiologies and presentations, makes achieving a definitive diagnosis challenging, even after extensive investigations.

Munchausen Syndrome, first described by Richard Asher in 1951, was named after Baron von Munchausen, a fictional character inspired by s German military officer known for his exaggerated tales of adventure. Among various factitious disorders, Munchausen Syndrome stands out due to the chronic nature of the sick role, persistent therapy-seeking behaviour, and an intense desire for attention. It is characterized by the deliberate fabrication and simulation of symptoms to assume the role of a patient (1).

Factitious disorders (FDs) in which a child or adolescent deliberately induces or falsifies illness to adopt the role of a patient receive relatively little attention. This condition typically occurs in older children and adolescents with medical conditions requiring treatment and hospitalization. It is often associated with a history of environmental or family deprivation, as well as emotional and physical abuse (2).

Dealing with factitious disorders can be challenging in adults, but could be bothersome in children, though each case comes with its complexities. There is a possibility that children might intentionally fabricate or exaggerate symptoms. The gap in awareness can lead to unnecessary testing and misdiagnosis, as clinicians might not initially consider that the young patients themselves might be responsible for their symptoms. Children and adolescents may have varied motivations for falsifying illness, such as seeking attention, evading school or social situations, or attempting to control certain dynamics at home or within their peer group. Unlike adults, younger patients may not fully grasp the potential risks of their behaviour, which can lead to unintentional harm through unnecessary medical interventions (3).

Factitious disorder imposed on self, previously known as Munchausen syndrome, is a psychiatric disorder characterized by an individual deliberately fabricating or inducing physical symptoms in themselves. The primary motivation is to assume the role of a sick person, without any apparent external incentives such as financial gain or other benefits. This disorder is particularly challenging to manage, as patients often deny their diagnosis when confronted and may become hostile. It is common for these individuals to leave medical facilities against professional advice, only to seek care at another hospital. Certain risk factors have been identified for this disorder, including being female, unmarried, and employed within the healthcare community. (2) These factors may contribute to the development and perpetuation of the condition, making it a complex issue to address in clinical settings.

I didn’t know how to ask for help or tell anyone how I was feeling. I was scared and felt alone, especially with my parents, especially my father, living away. When I started getting attention after the bleeding episodes, I felt cared for, even if it wasn’t real. During therapy, I slowly began to understand my feelings and found other ways to express myself. Now, I feel lighter, more in control, and I’m learning how to manage my stress in healthier ways. I’m glad someone finally listened without judging me.

Hemolacria, or bloody tears, is a sporadic condition with multiple potential causes, including tumours, conjunctivitis, trauma, retrograde epistaxis, inflammatory polyps, haemangiomas, and chloromas, among others. However, Munchausen syndrome can manifest with ophthalmic symptoms and should be considered in the differential diagnosis when a thorough evaluation fails to identify an underlying cause for ocular abnormalities.(3–5)Patients often present with prominent physical signs and symptoms, prompting urgent medical attention and hospitalization, with some even willingly consenting to invasive procedures. Alongside providing appropriate care, it is essential to reduce secondary gains and consider malingering as a differential diagnosis (6, 7). These patients often have an underlying trigger, such as a sudden loss of attention from others, leading them to fabricate symptoms to regain medical care. A thorough physical evaluation should be conducted promptly, as a diagnosis of Munchausen’s does not rule out the coexistence of an actual medical condition. Overall, Munchausen syndrome, along with the broader spectrum of factitious disorders, remains widely underdiagnosed by both psychiatrists and physicians(8). Haemolacria, though rare, is a distressing phenomenon and an unusual presentation of Munchausen syndrome. While the exact causes of Munchausen syndrome remain unclear, contributing factors may include parental neglect, childhood emotional trauma or illness, unresolved psychological conflicts, personality disorders, and other significant stressors (9).

Further research across diverse cultures is essential to unravel the psychological, social, and cultural dimensions of factitious disorders. This may ultimately pave the way for the development of innovative, culturally sensitive treatment approaches.

The author declares that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.