Introduction
bleeding, intraoperative bleeding, nasolacrimal duct, haemorrhage, tooth, NLD) obstruction, trauma
BLEEDING, BLOOD CLOT, OTHER SURGICAL PROCEDURES, LYSIS, COMPLICATION, HAEMORRHAGE, BLOOD DYSCRASIAS, INTRAOPERATIVE BLEEDING
Dacryocystorhinostomy (DCR) is a relatively common procedure performed by oculoplastic surgeons to create an anastomosis between the lacrimal sac mucosa and the nasal mucosa to bypass nasolacrimal duct (NLD) obstruction. External approach DCR remains the gold standard despite the wide use of the endoscopic approach [Control of intraoperative bleeding during DCR is of utmost importance as bleeding may obscure the already narrow operative field, making recognition of the sac wall or nasal mucosa very difficult [The amount of bleeding during external DCR varied in different studies but was reported between 3 and 25 ml [Many approaches have been adapted to avoid such complication, including pre-operative careful patient preparation, controlling blood pressure, ruling out blood dyscrasias, discontinuing anticoagulant and antiplatelets drug intake. Also, intraoperative use of epinephrine along with local anesthetics unless contraindicated by medical cause, appropriate surgical technique to avoid known blood vessels with judicious use of cautery and raising the head end of the surgical table [TXA (trans-4-aminomethyl cyclohexane carboxylic acid) is a synthetic lysine analogue that prevents breakdown of the blood clot by reversibly blocking the binding sites of plasminogen and prevents plasminogen activation to plasmin and the lysis of polymerized fibrin in the blood clot. Because of its hemostatic activity, wide availability, and limited side effects, it has also been widely studied for the prevention and treatment of haemorrhage in trauma and several types of elective surgery [TXA is used topically during tooth extraction, orthopedic procedures, cardiac surgery, and many other surgical procedures [The aim of this study is to compare the efficacy of gauze soaked with combined TXA (100 mg/ml) and epinephrine 1:200,000 versus using gauze soaked only with epinephrine 1:200,000 in intraoperative bleeding control in external Dacryocystorhinostomy.