Catamenial haemolacria and ocular pain as rare manifestations of extra-pelvic endometriosis

Ocular involvement in endometriosis is an exceptionally rare extrapelvic manifestation, typically presenting as catamenial haemorrhagia. We report the case of an adolescent girl who presented with recurrent eye bleeding and pain during her menstruation. A comprehensive physical examination and imaging, including orbital magnetic resonance imaging, were unremarkable. Hematologic and ophthalmological evaluations excluded coagulopathies and structural ocular pathologies. Given the cyclical pattern of her symptoms and the absence of other identifiable causes, a presumptive diagnosis of ocular endometriosis was made. The patient was treated with a combination of dienogest and ethinyl estradiol, leading to significant symptom improvement over a two-year follow-up period. Occasional minimal haemolacria persisted, but no further intervention was required. This case underscores the importance of considering endometriosis in the differential diagnosis of catamenial haemolacria, even in the absence of radiological confirmation. A multidisciplinary approach and individualized hormonal therapy can result in substantial symptom control and improved quality of life in affected patients with catamenial haemolacria.