Seventy-eight patients with femoroacetabular impingement syndrome were randomized to receive 1,000 mg IV tranexamic acid (TXA) in 100 mL saline (n=39) or placebo saline (n=39). The primary outcome was arthroscopic visual field clarity (VFC), graded every 15 minutes on a 3-point scale. Secondary outcomes included the percentage of good VFC scores, composite VFC averages, and treatment-related adverse events. Outcomes were assessed intraoperatively only. Overall, the results of the study revealed no significant between-group differences in mean VFC scores (2.51 ± 0.41 vs 2.64 ± 0.42; P=.16) or percentage of good VFC ratings (56.4% vs 66.4%; P=.17). No adverse events occurred in either group. In conclusion, TXA did not improve visualization, suggesting it should not be routinely used for VFC enhancement in hip arthroscopy.