7-year-old girl previously healthy with intermittent reversible episodes of proptosis of the left eye (OS) years ago on Valsalva maneuvers. She was diagnosed with left orbital varices and was followed up in another ophthalmology center with regular exams without any intervention. On the day of presentation, the patient presented with acute and painful left eye proptosis, that unlike other episodes in the past, did not resolve spontaneously. On ophthalmic exam, best-corrected visual acuity was 20/20 in both eyes. Pupils were equal, reactive, and there was no relative afferent pupillary defect (RAPD). Intraocular pressures (IOP) were 18 in both eyes (OU). Anterior segment exam showed extensive chemosis and proptosis OS. Fundus exam was normal OU. She was admitted and MRI of the orbits (Orbital MRI protocol without and with IV contrast, MRI 3T GE Discovery 750) showed an extraconal orbital serpentine oblong structure, showing central clotting, with blood products in keeping with left thrombosed orbital varix (Figure 1A). The diagnosis was further confirmed by a brain and orbital diagnostic cerebral angiogram (DSA), with arterial and venous timing, and 3D post processing obtained on a separate workstation and sent for analysis (Siemens ArtisQ Biplane). The diagnostic imaging features on the MRI, and DSA angiogram showed no sign of abnormal arterial feeder or early venous drainage suggesting the absence of an arteriovenous fistula or arteriovenous malformation. The patient did not show any spontaneous improvement or worsening over the next three days after admission. Proptosis and pain were significant so decision was made to intervene. After reviewing the literature and discussing with the interventional radiology department, decision was made for a percutaneous intervention and sclerotherapy of the thrombosed varices, using direct puncture and injection of liquid sclerosing mixture of Bleomycin. Using ultrasound and fluoroscopy guidance, access was obtained into the thrombosed varix, through a transcaruncular approach, using a 25G needle. Aspiration was not able to drain significant fluid or venous blood. A mixture of bleomycin and Sotradecol Sodium Tetradecyl Sulfate (SSTS 3% sclerosing agent) was mixed into a foam solution and injected into the varix, under real time fluoroscopy demonstrating the sclerosing solution filling and stagnating within the thrombosed venous varix (Figure 1B), confirmed with a DynaCT scan obtained directly at the time of the procedure. A canthotomy and cantholysis was also performed at that moment to release some of the intra-orbital pressure. Patient did well after the procedure. Subsequent control CT-Scan, showed an interval decrease in the size of the thrombosed varix in the left orbit, with hyperattenuation of the center of the varix, consistent with sclerosing agent diffusing and filling the thrombus. The patient was monitored over time and showed progressive improvement of her symptoms consistent with control radiology imaging. She remains stable two years after follow up, with no recurrence, no side effects, and 20/20 vision (Figure 2A-2B).