Purpose

In this paper we investigate the efficacy and safety of intralesional Bleomycin as a treatment for orbital lymphaticovenous malformations, focusing on its impact on lesion size reduction, symptom relief, recurrence and complication rate at King Khaled Eye Specialist Hospital (KKESH) a tertiary eye hospital.

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Methods

A retrospective observational case series, reviewing medical records of patients who have received intralesional Bleomycin treatment for orbital lymphaticovenous malformations at KKESH. The main objectives of this research are to assess the impact of intralesional Bleomycin on lesion size reduction, symptom relief, recurrence and complication rate.

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Results

Eighteen patients (66.7% female) with a mean age of 8.2 ± 8.1 years were treated with intralesional bleomycin for orbital lymphatic malformations. Periocular swelling (55%) and unilateral proptosis (44%) were the most common presenting features. Radiologically, lesions were classified as macrocystic (55%), microcystic (16%), or mixed (27%), with 61% located in both intra- and extraconal compartments. The mean lesion area significantly decreased from 671 ± 375 mm² at baseline, as measured on pre-injection imaging, to 279 ± 280 mm² on the first available post treatment radiological follow up, with a mean follow-up duration of 9.6 ± 16.4 months (range: 3–44.9 months).The average size reduction was 61%,with complete resolution in 11.8% of cases. No recurrence was observed during the follow-up period. The most frequent symptoms during presentation were proptosis and periocular edema, which were observed in 55% and 44% of patients, respectively. Within three months after the injection, clinical notes showed that 15 out of 18 patients (83.3%) had resolved or improved their presenting symptoms. Minor complications occurred in 27% of patients, with no systemic or respiratory adverse events reported.

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Conclusion

This study supports using bleomycin as a first-line therapy for orbital lymphatic venous malformations due to its availability, cost-effectiveness, and low complication rates.

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Additional Authors

First name	Last name	Base Hospital / Institution
Khawlah	Alzaben	King Khaled Eye Specialist Hospital
Shahad	Alrwile	King Khaled Eye Specialist Hospital
Rawan	Althaqib	King Khaled Eye Specialist Hospital
Sahar	Elkhamary	Mansoura Faculty of Medicine
Diego	Strianese	University of Naples

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