Tranexamic Acid for Blepharoplasty Surgery: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Periorbital ecchymosis and edema are common postoperative concerns in blepharoplasty surgery, negatively impacting recovery and patient satisfaction. Tranexamic acid (TXA), an antifibrinolytic agent, has shown promise in mitigating ecchymosis, but its efficacy and optimal administration route remain uncertain. This systematic review and meta-analysis evaluated the efficacy and safety of intravenous (IV) or subcutaneous TXA in blepharoplasty surgery.

A systematic search was conducted on PubMed, Embase, and Cochrane for randomized controlled trials comparing TXA to no TXA use in blepharoplasty. The primary endpoint was the ecchymosis score, evaluated at postoperative day (POD) 0, POD 1-3, and POD 7-9. Secondary outcomes included time to resume active daily living, operative time, intraoperative pain, and adverse events. Subgroup analysis compared IV and subcutaneous administration.

Five randomized controlled trials comprising 594 patients and 739 eyes were included. TXA significantly reduced ecchymosis scores at POD 0 (standardized mean difference [SMD]: -0.23; 95% confidence interval [CI]: -0.43 to -0.04; p = 0.02), POD 1-3 (SMD: -0.56; 95% CI: -0.81 to -0.31; p < 0.01), POD 7-9 (SMD: -0.65; 95% CI: -1.12 to -0.17; p < 0.01), and time to resume active daily living (MD: -1.22 days; 95% CI: -1.63 to -0.80; p < 0.01). Subgroup analysis revealed significant differences between subcutaneous (SMD: -0.36; 95% CI: -0.57 to -0.15; p < 0.01) and IV TXA (SMD: -0.97; 95% CI: -1.37 to -0.56; p < 0.01) on ecchymosis at POD 7-9. There were no adverse events related to TXA.

According to the current literature, TXA safely reduces ecchymosis and accelerates recovery in blepharoplasty, with a greater effect of IV administration in the late period. Further, high-quality randomized controlled trials using standardized ecchymosis grading scores are needed to validate these findings.