Dr. Kenneth Cahill reports on his experience using orbital sclerotherapy for treating lymphangiomas with periocular involvement of eyelids, conjunctiva, orbit, and face. These lesions often exhibit layers associated with blood degradation products. Thick fibrotic tissue can occur, especially with chronic lesions. Treatment can consist of observation or emergent aspiration when vision or the cornea are at risk. For sclerotherapy, there is no single agent or single treatment protocol that works for all lesions. The most potent way Dr. Cahill treats macrocysts is with STS/ethanol, though postoperative drainage is needed. Bleomycin foam prepared with 25% human serum albumin is the most frequently used sclerosing agent. It seems to cause the least swelling and inflammation. When used in relatively low doses, its risks of pulmonary fibrosis and skin hyperpigmentation are diminished. Doxycycline can also be used, though it causes more inflammation and swelling than bleomycin. For this reason, it is primarily used for small- to medium-sized cysts in the eyelids, especially if bleomycin has not been effective. Both doxycycline and bleomycin have side effects and need to be monitored. Their benefit might be partially lost if discontinued.