Purpose

To describe the multimodal management of a congenital orbital lymphangioma in a pediatric patient using transconjunctival orbitotomy and serial intralesional bleomycin injections.

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Methods

A 10-year-old girl with no relevant medical history presented with a congenital untreated left orbital mass. She was referred in October 2023 due to progressive orbital enlargement over 4 months following a viral infection. An incisional biopsy performed elsewhere had suggested lymphangioma. Examination revealed a visual acuity of 20/20 in the right eye and 20/100 in the left eye, left hypoglobus, 2 mm lagophthalmos, and 19 mm of left-sided proptosis compared with 14 mm in the contralateral eye. Computed tomography demonstrated an intra- and extraconal lesion with predominant nasal and superior extension, poor contrast enhancement, encasement of the optic nerve, and close contact with the superior and medial rectus muscles.

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Results

In January 2024, the patient underwent transconjunctival orbitotomy, biopsy, and intralesional bleomycin injection without complications. One month postoperatively, left exophthalmometry decreased by 7 mm, reaching 12 mm. Four months later, recurrent periorbital enlargement prompted a second ultrasound-guided bleomycin injection. Follow-up computed tomography performed 3 months later showed significant reduction in lesion size. Due to subsequent frontal and periorbital progression, two additional bleomycin injections were administered in September and November 2024.

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Conclusion

Orbital lymphangioma remains a therapeutic challenge because of its infiltrative nature and high recurrence rate. Intralesional bleomycin combined with conservative surgical management may achieve substantial tumor volume reduction, improve cosmetic appearance, and avoid more aggressive procedures. Close follow-up is essential given the risk of recurrence

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Additional Authors

First name	Last name	Base Hospital / Institution
Karen Liliana	Gutiérrez-Verduzco	Fundación Hospital Nuestra Señora de la Luz I.A.P.
Jesús Antonio	Medellin-Fournier	Fundación Hospital Nuestra Señora de la Luz I.A.P.
Gerardo	Graue-Moreno	Fundación Hospital Nuestra Señora de la Luz I.A.P.
Zair Omar	Salgado-Mancilla	Fundación Hospital Nuestra Señora de la Luz I.A.P.

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