Interventions for reducing bleeding and swelling in eyelid and periocular surgeries: a systematic review of randomized controlled trials.

PURPOSE: To systematically evaluate evidence-based interventions aimed at reducing postoperative edema and ecchymosis in eyelid and periocular surgery, with the goal of improving patient outcomes and recovery.

METHODS

A systematic review of 29 randomized controlled trials (RCTs), involving 2,287 patients undergoing eyelid and periocular surgery, was conducted. A comprehensive search was performed across Embase, MEDLINE, Cochrane Central, and Google Scholar up to April 2025. Studies assessing interventions for postoperative edema and ecchymosis were included. Study quality was evaluated using the Cochrane Risk of Bias 2 (RoB 2) tool.

RESULTS

Tranexamic acid was the most consistently effective intervention for reducing ecchymosis. Vessel-preserving surgical techniques significantly reduced edema and hematoma, while skin-only excision led to less swelling than combined skin and muscle excision. Carbon dioxide laser - assisted blepharoplasty improved hemostasis and reduced chemosis. Magnesium sulfate dressings were more effective for edema than ice packs, though cold compresses provided short-term relief. Anesthesia modifications (pre-cooling, buffered lidocaine) reduced injection pain but had variable effects on swelling. Herbal and adjunctive therapies, including Arnica montana and bromelain, showed no significant benefits.

CONCLUSION

Tranexamic acid, vessel-preserving surgical methods, and magnesium sulfate dressings are among the most effective strategies for minimizing ecchymosis and edema in eyelid and periocular surgery. Further RCTs should explore optimized combinations of these interventions and assess long-term patient-reported outcomes.