Sclerotherapy in Orbital and Peri-Orbital Pathology: A Systematic Review of Current Applications and Emerging Frontiers

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.