Tranexamic acid in oculofacial plastic surgery: a review of current evidence

Purpose of review Oculofacial plastic and orbital surgery is performed in an anatomic region where even modest bleeding can result in significant morbidity. Tranexamic acid (TXA) use in the perioperative period has demonstrated safety and efficacy in reduce intraoperative bleeding and postoperative ecchymosis. This review discusses perioperative TXA use and antithrombotic management in oculofacial surgery. Recent findings Prospective and randomized studies in eyelid, periocular, nasolacrimal, and facial aesthetic surgery demonstrate that intravenous, oral, and local TXA reduce postoperative ecchymosis and edema, and in some settings decrease intraoperative blood loss and operative time. Safety data across surgical specialties consistently show no increased risk of thromboembolic complications. However, prospective evidence guiding perioperative continuation vs. cessation of antithrombotic therapy in oculofacial surgery remains limited. Summary TXA is a safe, cost-effective adjunct that improves postoperative recovery in oculofacial plastic surgery. While current evidence supports its routine use in selected procedures, further research is needed to define its role in orbital surgery and in patients maintained on chronic antithrombotic therapy.