How can hemostasis be achieved after excising a skin tag from the eyelid?

Hemostasis After Eyelid Skin Tag Removal

Apply direct manual pressure to the bleeding site for several minutes using sterile gauze—this is the most effective first-line method for achieving hemostasis after minor eyelid procedures. 1

Immediate Hemostatic Measures

Primary Approach: Direct Pressure

• Apply firm, continuous direct manual pressure over the bleeding area using sterile gauze for at least 5-10 minutes without interruption. 1
• Maintain pressure by applying an elastic adhesive bandage over gauze pads if bleeding persists after initial pressure application. 1
• Avoid using pressure points (indirect pressure) or elevation alone, as these lack evidence for effectiveness in controlling bleeding. 1

Adjunctive Hemostatic Options

• Consider using extra sutures at the excision site if direct pressure alone is insufficient. 1
• Apply gauze soaked in tranexamic acid (5% solution) to the bleeding site as a pro-hemostatic agent, though this is extrapolated from dental procedure evidence. 1
• Ensure adequate wound closure technique to prevent chronic low-grade inflammation that could lead to delayed bleeding. 2

Post-Procedure Wound Care

Immediate Post-Operative Management

• Apply white soft paraffin ointment or greasy emollient to the eyelid every 2 hours during the first 24-48 hours to maintain moisture and promote healing. 1
• Use a bandage contact lens or protective dressing if there is concern about corneal exposure from eyelid manipulation. 1
• Consider topical antibiotic ointment applied to the surgical site, though evidence for infection prevention in minor procedures is limited. 3

Monitoring and Follow-Up

• Perform daily examination of the surgical site during the acute healing phase (first 3-5 days) to identify any delayed bleeding or complications. 1, 4
• Instruct patients to avoid aggressive eyelid pressure or manipulation, especially if they have glaucoma, as this may increase intraocular pressure. 4, 5
• Advise patients to avoid sunlight and heavily scented facial products for 24 hours post-procedure. 1

Critical Pitfalls to Avoid

Common Errors in Hemostasis Management

• Do not apply ice or ice water to eyelid wounds, as cooling with ice increases tissue damage. 1
• Avoid premature removal of pressure before adequate hemostasis is achieved—most providers fail to apply pressure for sufficient duration. 1
• Do not use tourniquets or circumferential pressure around the eyelid, as this can cause tissue injury and has no role in minor dermatologic procedures. 1

Anticoagulation Considerations

• If the patient is on antiplatelet therapy (aspirin or P2Y12 inhibitors), continuation of these medications is generally safe for minor dermatologic procedures, with bleeding incidence remaining low (<5%). 1
• For patients on vitamin K antagonists (warfarin), most bleeding from minor skin procedures is self-limiting, though VKA interruption may be preferred for procedures where considerable bleeding is expected. 1
• Avoid routine bridging therapy with heparin or other anticoagulants for minor procedures. 1

When Hemostasis Fails

Escalation Strategy

• If direct pressure for 10 minutes fails to control bleeding, place additional sutures to close any bleeding vessels. 1
• Consider cautery (chemical or thermal) for persistent bleeding from small vessels, though this should be used judiciously near the eyelid margin. 1
• If bleeding cannot be controlled with these measures or if there is concern for retrobulbar hematoma (severe pain, proptosis, vision changes), obtain urgent ophthalmology consultation. 1, 4, 5

Red Flags Requiring Immediate Referral

• Proptosis or forward displacement of the eye. 5
• Severe pain, especially with eye movement. 5
• Decreased visual acuity or vision changes. 5
• Expanding hematoma or significant eyelid swelling that prevents eye opening. 1