PURPOSE: The purpose of this study was to report recurrent hemolacria, or 
"bloody tears," as a sign of scleral buckle (SB) infection.
METHODS: This is an interventional case series of three eyes of three patients 
with hemolacria after SB placement.
RESULTS: Two men and one woman were treated for recurrent hemolacria after SB 
placement for a rhegmatogenous retinal detachment. Two patients had an 
encircling silicone sponge placed, one 6 years and the other 3 years before 
presentation. The third patient had a segmental solid silicone element placed 3 
months before presentation. Two of the patients reported between 6 to 10 
episodes of hemolacria occurring for "years" before referral and diagnosis. In 
all three patients, hemolacria originated from an occult conjunctival fistula 
overlying or adjacent to an exposed SB. Microbiological cultures grew 
Staphylococcus aureus in two eyes and polymicrobial growth in the other. 
Hemolacria resolved with explantation of the SB in two patients and with 
long-term continuous topical antibiotics in the other patient.
CONCLUSION: Hemolacria can be a sign of a SB infection and should raise a high 
level of suspicion for the presence of an occult conjunctival fistula with 
exposure of the underlying scleral buckling element when frank exposure is not 
seen.