Mass lesions above the medial canthal tendon are of particular concern for malignancy or other atypical process. Digital palpation of the lacrimal sac over the lacrimal sac fossa region and upward may be revealing and should be compared to the opposite side in unilateral cases. A patient with a bleeding diathesis leading to the abnormal tearing may also have Subconjunctival Hemorrhage. If factitious disorders suspected - is anyone with the patient immediately prior to the episode?Įxamination should include thorough slit lamp examination of the conjunctiva (including everting upper lids to fully examine palpebral conjunctiva), lacrimal gland and puncti for any lesions, changes in anatomy or other unusual findings.Other Bleeding- particularly Epistaxis, Hemoptysis, spitting up blood.
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