Foam Sclerotherapy as an alternate method for Periorbital Dermoid cases with Surgical Constraints: A Prospective study.

Objective: To analyze the efficacy and safety of foam sclerotherapy in medically unfit patients with periorbital dermoid cysts.

Design: This was a prospective interventional single-center study conducted from February 2018 to January 2024.

Participants: All patients who were diagnosed with periorbital cysts and were medically unfit for surgery were included in the study.

Methods: All patients were treated with foam sclerotherapy using 3% sodium tetradecyl sulfate (STS). The cyst was aspirated using a wide-bore needle, followed by the injection of intralesional foam sclerotherapy in a ratio of 2:1 of the aspirate. The aspirated contents were sent for cytopathology. Outcome measures included regression of the lesion, side-effects, and recurrence.

Result: Eleven patients were included in the study who were diagnosed with periorbital dermoid, and all were medically unfit for the surgery. Cysts were located in the medial angular region (four cases), lateral (three cases), intradiploic (two cases), and medial canthus (two cases). Comorbidities included poorly controlled diabetes with chronic kidney disease (five patients), severe coronary insufficiency (three patients), hypercoagulable states (two patients), and restrictive pulmonary disease with severe trismus (one patient). The mean aspirate was 3.5 mL, and a range of 1-3 injections was required. At a mean follow-up of 22.6 months, 82% showed complete remission. Two patients had partial resolution. There were no sclerotherapy-related complications or recurrence.

Conclusion: Foam sclerotherapy with 3% STS is a safe and effective alternative for treating periorbital dermoid in medically unfit patients. It helps to achieve complete resolution in the majority of cases without significant complications.