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Tranexamic Acid in Dacryocystorhinostomy: A Systematic Review
Angeliki Kollatou1, Konstantina N Sorkou2,1, Argyrios Tzamalis3,1
1Ocular Surgery, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, GRC.
Cureus
|April 6, 2026
Summary
Tranexamic acid (TXA) may reduce bleeding and surgical time in dacryocystorhinostomy (DCR). However, evidence is limited by small studies and subjective measures, necessitating further research for definitive conclusions.
Area of Science:
- Ophthalmology
- Surgical Innovation
- Pharmacology
Background:
- Dacryocystorhinostomy (DCR) for nasolacrimal duct obstruction (NLDO) often faces challenges with intraoperative bleeding, impacting surgical efficiency.
- Tranexamic acid (TXA), an antifibrinolytic agent, is explored for its potential to mitigate bleeding in various surgical settings.
Purpose of the Study:
- To systematically review randomized controlled trials (RCTs) evaluating the efficacy of tranexamic acid (TXA) in dacryocystorhinostomy (DCR).
- To assess TXA's impact on intraoperative bleeding, surgical duration, and surgical field clarity during DCR procedures.
Main Methods:
- A systematic review adhering to PRISMA guidelines.
- Searched PubMed/MEDLINE, Cochrane, and Google Scholar databases up to March 30, 2025.
- Included four RCTs with 286 patients comparing TXA (intravenous or topical) with placebo or alternative agents.
Main Results:
- Two studies showed significant reductions in intraoperative hemorrhage and surgical duration with TXA (IV and topical).
- One study found no significant difference in outcomes; another indicated superior efficacy of hydralazine and remifentanil over TXA.
- Improvements in surgical field clarity and surgeon satisfaction were noted but not statistically significant.
Conclusions:
- Tranexamic acid (TXA) shows potential for reducing intraoperative bleeding and surgical time in DCR via both intravenous and topical routes.
- Current evidence is limited by small sample sizes, variable outcome measures, and subjective assessments.
- Further high-quality research is needed to confirm efficacy and determine optimal dosing regimens for TXA in DCR.
