Purpose <p>This study investigates the impact of herbs (Ginger, Garlic and Green tea) and perioperative factors on intraoperative and postoperative hemorrhage as well as ecchymosis in external dacryocystorhinostomy.</p> Methods <p>This was a case series study that included 50 external DCR procedures performed on adults. Patients’ herbal use and other risk factors were questioned before the surgery. During the procedure, intraoperative hemorrhage volume and other parameters were documented. Postoperative hemorrhage and ecchymosis were evaluated on the day following the surgery. We used Regression analysis to assess the factors associated with hemorrhage complications in external DCR.</p> Results <p>The average amount of intraoperative hemorrhage was 81.66&#xa0;ml. Moderate to severe postoperative hemorrhage and ecchymosis occurred in 27.7 and 40.8% of cases, respectively. Upon conducting linear regression analysis, intraoperative MAP was the only factor associated with intraoperative hemorrhage. A significant association of ginger and intraoperative MAP with postoperative hemorrhage was revealed through multiple regression analysis. Additionally, the factors associated with postoperative ecchymosis were older age and urban residence.</p> Conclusions <p>We identified several factors associated with hemorrhage complications in external DCR procedure, including ginger use, intraoperative MAP, older age, and urban residence. Based on our findings that ginger intake before surgery can increase the hemorrhage risk, patients should be meticulously questioned about ginger use prior to external DCR and be recommended to cease its use.</p>