Long Standing Orbital Varix Successfully Managed with Intralesional Bleomycin Sclerotherapy: A Case Report

Varices are rare, congenital, abnormally dilated venous channels that may be found in conjunctiva or extend into the orbit. They may remain clinically silent for years before becoming symptomatic. Their management is challenging because of the lesion’s distensibility, potential for acute thrombosis, and surgical inaccessibility. We present a case of a 40-year-old male with a longstanding, progressively enlarging conjunctival mass and intermittent right-sided proptosis since childhood, exacerbated by Valsalva maneuvers. Visual acuity was 6/6 in both eyes. Slit-lamp examination revealed an irregular lobulated conjunctival lesion extending towards the superior fornix with peripheral corneal encroachment. Orbital CT demonstrated a low-flow venous malformation. Three monthly sessions of intralesional bleomycin resulted in marked reduction of lesion size and complete resolution of proptosis. Intralesional bleomycin sclerotherapy is a safe, minimally invasive, and effective treatment modality for orbital venous malformations, offering excellent cosmetic and functional outcomes while avoiding the morbidity of surgical excision.