Purpose

Orbital venous-lymphatic malformations (VLMs) are complex vascular anomalies with diverse clinical manifestations that pose significant therapeutic challenges due to their proximity to critical orbital structures and risk of visual loss. Different treatment modalities are available but none is always and totally effective. The purpose of this study is to describe the clinical presentation, management, and outcomes of orbital
VLM cases across different age groups.

---

Methods

Retrospective study of patients with orbital VLMs treated at Unidade Local de Saúde de Coimbra (July 2010–September 2025), representing available management approaches. All patients underwent ophthalmic examination and orbital imaging with computed tomography and/or magnetic resonance. Clinical photographs, treatment response, number of sessions, and procedure-related complications were systematically documented and analyzed.

---

Results

Five patients (9–52 years) with orbital VLMs were analyzed. Treatments included intralesional bleomycin, oral sirolimus, and surgery, with most receiving multimodal therapy. Bleomycin led to lesion regression and symptom improvement in all cases, though one required ongoing treatment for residual maxillary disease. Sirolimus stabilized two refractory cases, while surgery achieved complete resolution in two well-circumscribed lesions. No major ophthalmic or systemic complications occurred.

---

Conclusion

Management of orbital VLMs is challenging due to proximity to critical structures, recurrence risk, and hemorrhagic complications. In this series, multimodal therapy (bleomycin, sirolimus and surgery) was well tolerated, with no complications. Surgery and embolization achieved good outcomes in selected well-defined lesions. Bleomycin provided effective control and symptom relief, while sirolimus showed promising results
in refractory microcystic lesions. Overall, individualized multimodal strategies appear safe and effective across ages, lesion types, and severities.

---

Additional Authors

First name	Last name	Base Hospital / Institution
Telma	Machado	ULS Coimbra
Nuno	Gouveia	ULS Coimbra
Joana	Providência	ULS Coimbra
Filipa	Ponces	ULS Coimbra
Guilherme	Castela	ULS Coimbra

↑ Back to top