Purpose

To describe a targeted bleomycin delivery technique using blood aspiration and retrograde injection for the treatment of a low-flow venous malformation involving the lacrimal gland region.

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Methods

A 24-year-old female presented with a 10-year history of intermittent, position-dependent swelling of the left superotemporal eyelid, exacerbated by Valsalva maneuver and dependent positioning. Clinical examination revealed a soft 2.5 x 3.5 mm compressible, vascular lesion involving the lacrimal gland with associated tortuous superficial palpebral conjunctiva vessels. Magnetic resonance imaging (MRI) demonstrated a mild enlargement of the left lacrimal gland. Orbital Doppler ultrasound confirmed the absence of high-flow vascular characteristics or deep orbital extension. The patient underwent targeted bleomycin sclerotherapy using blood aspiration and retrograde injection of a prominent superficial conjunctival feeder vessel, supplemented by adjacent subconjunctival and subcutaneous injections to ensure adequate tissue distribution.

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Results

At one week, there was marked symptomatic improvement with reduction in swelling. At seven weeks, the lesion regressed to a flat telangiectatic remnant. At six months, approximately 50% reduction in lesion size was observed, with complete resolution of symptoms and no functional or structural complications allowing her to proceed with a subsequent pregnancy.

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Conclusion

Targeted bleomycin sclerotherapy using blood aspiration and retrograde injection represents a precise and minimally invasive approach for anterior periocular low-flow venous malformations. This technique may enhance sclerosant delivery while minimizing the risks associated with surgical excision or blind intralesional injection

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Additional Authors

First name	Last name	Base Hospital / Institution
Khawlah	Alzaben	King Khaled Eye Specialist Hospital & Research Center
Mashael	Alkhayyal	King Khaled Eye Specialist Hospital & Research Center

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