Intralesional bleomycin: a potential treatment for refractory orbital lymphangiomas

The authors present 4 cases of orbital lymphangioma that had not responded to conventional therapy but responded positively to intralesional bleomycin injections. In this retrospective case series, patients were recruited from the Oculoplastics Clinic at Tygerberg Academic Hospital with histologic and/or radiologic evidence of microcystic and macrocytic deep and/or combined orbital lymphangioma. All 4 cases had multiple prior intralesional steroid injections. Three had previous intralesional bevacizumab, and 2 had prior radiotherapy. Under anesthesia, a solution containing 1 IU bleomycin per milliliter saline together with 2% lignocaine was injected in the lesion. Retreatments were performed every 4 to 8 weeks if needed. A total of 1 to 6 intralesional bleomycin injections were used to treat the 4 cases. All 4 cases showed significant regression with marked clinical improvement. No systemic or ophthalmic side effects were noted. From this series, the authors suggest that intralesional bleomycin injections might be considered as a first-line agent in cases of untreated microcystic and macrocytic deep and/or superficial orbital lymphangiomas or as an alternative treatment option for refractory cases.