Objectives This study conducted to evaluate and compare between topical tranexamic acid (TA) and hot saline as an alternative to local vasoconstrictors on bleeding and surgery site quality during endoscopic sinus surgery (FESS). Patients and methods This study was performed on 75 patients with class I and II American society of anesthesiologists (A.S.A.), scheduled for elective FESS under general anesthesia. Patients divided into three groups, each (25 patients), group A: topical tranexamic acid (1000mg diluted in 20ml normal saline) was used during surgery for packing and irrigation, group B: hot saline up to 50°C was used and group C :(control group) normal saline was used. Results The use of local (TA) was associated with signifi cant decrease in estimated blood loss 214.2 ml more than local hot saline which was 216.75 and both is much better than the normal saline which was 272.66. Also (TA) and hot saline showed decrease in the duration of surgery, improve the surgical fi eld quality and blinded surgeon satisfaction as compared with the control group. Conclusion The use of local TA and local hot saline up to 50°C achieved reduction in blood loss, duration of surgery and improved surgical fi eld quality during FESS.