Sclerotherapy for eyelid and anterior orbital venous-lymphatic malformation

Abstract

Purpose To assess the efficacy of sclerotherapy with sodium tetradecyl sulfate (STS; Fibrovein 1%) in superficial periocular venous and lymphatic malformations. Methods Eleven patients with low-flow venous and lymphatic malformations with extension predominantly to the eyelids, conjunctiva, and anterior orbit were selected. Sclerotherapy with STS was undertaken as an office-based procedure without any radiological guidance. Injections were repeated every 4 weeks until desired response occurred. Therapeutic effect was assessed objectively by change in the size of the lesions in serial photography. Results The lesions completely resolved in 4 cases with small eyelid and fornix lesions. In other 7 cases there was partial resolution to less than half of primary size. We did not have any significant complications. Conclusion Sclerotherapy with STS is an easy and effective modality for treatment of venous-lymphatic malformations and can be undertaken as an office-based procedure in lesions which are limited to eyelids and anterior orbit.

Sclerotherapy in orbital lymphangioma: A case report

“…When this agent is injected intravenously, it causes intimal inflammation and thrombus formation, which usually occlude the injected vein. Following the formation of fibrous tissue, the vein is partially or completely obliterated, which may or may not be permanent [ 13 , 14 ]. Bleomycin is a cytostatic antineoplastic agent that inhibits the rapamycin (mTOR) pathway.…”

Orbital Venolymphatic Malformation Treated With Sodium Tetradecyl Sulfate: A Case Report

“…This agent was chosen due to its relative high potency compared to various other available agents. However, its disadvantage is it produces remarkable swelling in the first one to five post-procedure days, injection site pain, skin eruptions, skin discoloration, superficial thrombophlebitis and grave adverse effects such as anaphylactic shock and possible neurological injury [ 2 , 4 ]. Microcystic lesions (< 10 mm) can be managed by doxycycline, sirolimus or surgery, whereas macrocystic lesions can be treated by the stimulation of the lining endothelium by STS, bleomycin, Picibanil (OK‑432) or 60%-100% ethanol [ 8 , 9 ].…”

“…It is established that patients with widespread facial venous malformations have a high incidence of associated intracranial developmental venous anomalies (DVAs) [ 3 ]. Various percutaneous intralesional sclerosing agents like sodium tetradecyl sulfate (STS), bleomycin, doxycycline, ethanol and OK-432 (Picibanil) have been used as first-line treatment for VLMs elsewhere in the body [ 4 ]. We describe a rare case of retro-orbital VLM treated successfully with STS injection and an isolated dural arterio-venous (AV) fistula in the same patient.…”

Recurrence of Distensible Orbital Venous-dominant Venolymphatic Malformations After Sclerotherapy Versus Embolization With Excision

“…15 Common sclerosing agents include sodium morrhuate 5%, sodium tetradecyl sulfate 3%, absolute ethanol, picibanil (OK-423), bleomycin, and tetracyclines. 17 Multiple case series have demonstrated at least early success in treating orbital venous malformations with sclerotherapy, including bleomycin, [3][4][5][6][7][8] ethanol, 3,9,10,15 sodium tetradecyl sulfate, 4,11,12,15 doxycycline, 15 and pingyangmycin. 10,13,14 However, a recent systematic review of the literature, which analyzed 12 studies containing 142 patients with orbital VLMs, found that only 55% of patients experienced complete cure, with 45% experiencing partial cure.…”

“…Treatment for distensible orbital venous-dominant VLM commonly includes 3 major options: sclerotherapy, surgery, and embolization followed by surgical excision. While some case series have demonstrated initial success in managing venous-dominant VLM with minimally invasive sclerotherapy, [3][4][5][6][7][8][9][10][11][12][13][14] they often require multiple treatments and have a tendency to recur over time. 15 These lesions may also be surgically excised, with or without the assistance of vascular clips, though there is a significant risk of uncontrolled hemorrhage.…”