Lymphangiomas are benign hamartomatous venolymphatic malformations (VLMs) composed of variable venous and lymphatic components. They often involve the orbit, as well as the periocular structures such as the lids and the conjunctiva. The fact that orbital lymphangiomas (OLMs) generally have minimal internal blood flow and an absence of connection to the vascular system (no-flow vascular malformations) makes them very amenable to sclerotherapy. In sclerotherapy, a sclerosant is injected into the cystic spaces of the lesion, leading to scar formation and reduction in size. This video demonstrates the radiological and clinical features of periocular and orbital lymphangiomas. Step by step, the video demonstrates the use of bleomycin in both macrocystic OLMs and diffuse conjunctival and periocular VLMs. It also illustrates the dilution and preparation and the steps of injection into the lesion. With high-quality before and after clips, the video shows how bleomycin can be effectively used to treat orbital and periocular VLMs.

Financial Disclosures: Dr. Akshay Gopinathan Nair discloses financial relationships with Cadillac Healthcare (Equity Stockholder - Public Company); Carl Zeiss Meditec (Lecture Fees/Speakers Bureau); and HelpMeSee Inc. (Consultant/Advisor).

Financial Disclosures: Drs. Tarjani Dave and Priti Udhay disclose no financial relationships.