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Purpose

Introduction: Tranexamic acid (TXA) is an antifibrinolytic agent that has been shown to reduce ecchymosis following periocular surgery. While thrombotic events and seizures have been reported with high plasma concentrations of intravenous TXA, the safety profile of subcutaneous TXA remains incompletely characterized. We hypothesize that locally administered TXA with anesthetic for oculofacial surgery is associated with low rates of both injection site and systemic complications.

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Methods

Methods: A retrospective cohort study was performed via chart review at a single tertiary care center. Analysis included patients who underwent oculoplastic surgery procedures from July 2023 to April 2026. The anesthetic admixture consisted of 1% lidocaine with 1:100,000 epinephrine, 0.5% bupivacaine, tranexamic acid (100 mg/mL), and 8.4% sodium bicarbonate in a 3:3:3:1 ratio, respectively. Patients on anticoagulants medications were excluded.

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Results

A total of 4,356 patients who received local TXA injection during oculofacial surgery were included. TXA was utilized across all surgical categories: eyelid (n=2,114), lacrimal (n=1,159), orbital (n=612), and cosmetic (n=471). Minimal local injection site complications were identified, including tissue ischemia (n=2, 0.05%), allergic reaction (n=0), delayed wound healing (n=0), or retinal vascular occlusion (n=0). No systemic adverse events were observed, including anaphylaxis (n=0), seizure (n=0), venous thromboembolism (n=0), or cerebrovascular accident (n=0). Hemorrhagic events (n=14, 0.32%) were encountered despite usage of local TXA, with only one (0.02%) retrobulbar hemorrhage.

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Conclusion

In the largest retrospective series of adult and pediatric patients to date, locally administered TXA in oculofacial plastic surgery was associated with minimal injection site or systemic complications. Hemorrhagic events were rare with only 0.02% rate of retrobulbar hemorrhage. These findings support the safety of local TXA use across a broad range of oculofacial procedures.

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Additional Authors

First name	Last name	Base Hospital / Institution
Daniel	Azzam	University of California, Irvine
Teresa	Chen	Kasier Permanente
Lilangi	Ediriwikrema	University of California, Irvine
Jeremiah	Tao	University of California, Irvine

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