Objective To investigate the clinical efficacy of water light injection of tranexamic acid assisted fractional laser for rosacea treatment. Methods A total of 50 patients with rosacea admitted to Xingyi People’s Hospital from January to December 2023 were divided into control group and observation group by lottery method, with 25 patients in each group. The control group was treated with fractional laser, and the observation group was treated with fractional laser combined with tranexamic acid. The clinical efficacy, erythema area, erythema index and adverse reactions were compared between the two groups. Results The total clinical efficacy rate in the observation group was higher than that in the control group, and the erythema area, erythema index, TEWL and LAST score were lower than those in the control group (P <0.05). There was no significant difference in the incidence of adverse reactions between the two groups (P >0.05). Conclusion In the treatment of rosacea, water light injection of tranexamic acid and lattice laser can improve clinical efficacy, reduce erythema area and erythema index, improve skin condition, and have high safety.