PURPOSE:: This study was performed to ascertain the incidence of anticoagulant use in oculoplastic surgical patients and the reliability of patient medication disclosure. Differences in perioperative bleeding complications among patients continuing anticoagulants, those who withheld the medications, and those not anticoagulated were investigated. METHODS:: Following institutional review board approval, a retrospective chart review was conducted (January 1, 2008, to June 30, 2010). Anticoagulant medications and their management during the perioperative period were reviewed. Type of surgical procedure and perioperative complications were documented. RESULTS:: Charts were reviewed for 1130 surgeries in 1015 patients. Eighteen percent of patients failed to accurately disclose their medication use. Aspirin use was not reported in 12% of patients. There were no intraoperative complications and a single postoperative orbital hematoma among 682 patients not using anticoagulants. There were 3 intraoperative complications and 1 postoperative hemorrhage in the 207 patients whose anticoagulants were withheld. In the 145 patients who continued their anticoagulation therapy throughout the surgical period, there were no intraoperative bleeding complications, and one postoperative hemorrhage. None of the study patients sustained permanent visual deficit or deformity related to hemorrhage. CONCLUSIONS:: Forty percent of patients undergoing oculoplastic procedures were using anticoagulants; yet, many patients failed to disclose their medication usage. The decision to operate and whether to discontinue these medications must be individualized considering the nature of the procedure and the patient's medical condition. It may be appropriate to continue anticoagulants in certain patients at increased risk for a vascular event, ensuring adequate hemostasis throughout the procedure.