Catamenial bilateral conjunctival hemorrhage associated with endometriosis: A rare case report

Objective: To present a rare case of catamenial bilateral conjunctival hemorrhage associated with endometriosis in a patient with ovarian endometrioma and to discuss its possible hormonal pathogenesis. Case: A 24-year-old nulliparous woman presented with a 10-year history of severe dysmenorrhea and recurrent bilateral subconjunctival hemorrhage occurring exclusively during menstruation. Ophthalmologic examinations revealed no additional pathology. Pelvic ultrasonography demonstrated a 70×55-mm homogeneous cystic lesion with low-level internal echoes in the right ovary, consistent with an endometrioma. Serum CA-125 was mildly elevated (48.5 U/mL). Orbital magnetic resonance imaging was normal. Combined oral contraceptive therapy containing drospirenone and ethinylestradiol was initiated, resulting in marked improvement in both dysmenorrhea and ocular hemorrhage. Conclusion: Catamenial conjunctival hemorrhage is a rare but clinically relevant manifestation that may be hormonally mediated. In patients presenting with cyclic ocular bleeding, underlying endometriosis should be considered.