Sclerotherapy in Orbital and Peri-Orbital Pathology: A Systematic Review of Current Applications and Emerging Frontiers
In brief
Intralesional bleomycin achieves 86% success in orbital lesions, complications under 2%
A systematic review of 108 studies found that bleomycin injected into orbital vascular lesions produced a favorable response in about 86% of 269 evaluable patients, with sight-threatening complications in only 1.3%. Evidence remains low-level and non-vascular uses are varied, underscoring the need for prospective registries and standardized reporting.
- Journal
- Seminars in ophthalmology (Q2)
- Published
- 6 September 2026
- Study design
- Systematic review / meta-analysis of RCTs
- Evidence level
- Level 1, High (CEBM 1a)
- Authors
- Ayushi Agarwal, Prerna Sinha, Arman A Khan, Jessica Y Tong, Dinesh Selva
- PMID
- 42701885
- DOI
- 10.1080/08820538.2026.2727974
Why clinicians should know about it
- Picked for Ophthalmology (top studies of the week, 13 September 2026): Systematic review of orbital sclerotherapy, low relevance
Abstract
AIM: To highlight current and emerging applications of sclerotherapy in orbital and peri-orbital pathology while identifying evidence gaps and future directions. METHODS: Systematic review of 108 studies identified through PubMed, Embase, Scopus, and Web of Science databases from inception to April 2026 with independent dual-reviewer screening. RESULTS: Of the 108 included studies, 82 (75.9%) addressed vascular indications and 26 (24.1%) addressed non-vascular indications. All evidence was low-level (Level 3 or 4), with no randomized trials identified. A pooled analysis of 315 cases managed with intralesional bleomycin achieved a favourable response in 86.2% of evaluable patients (n = 269), with sight-threatening complications in 1.3% (n = 4) cases. Non-vascular indications spanned dermoid cysts, conjunctival, orbitopalpebral, and eyelid cysts, intrascleral cysts, xanthelasma, malar festoons, and lacrimal sac obliteration. Foam sodium tetradecyl sulphate demonstrated the broadest indication profile, while trichloroacetic acid was the most common sclerosant for conjunctival cysts in anophthalmic sockets. Bleomycin showed higher response rates in macrocystic variant than microcystic or previously intervened disease. Routine image-guidance appeared prudent, particularly for deep, complex, or distensible orbital vascular lesions. CONCLUSION: Sclerotherapy is a versatile, minimally invasive modality applicable across a broad spectrum of orbital and peri-orbital pathologies. Prospective registries employing standardized ISSVA-based lesion classification and outcome reporting are warranted to formulate evidence.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.