A Case of Periorbital Infantile Capillary Hemangioma Treated With Propranolol

Eun Kyoung Lee; Ho-Kyung Choung; Nam Ju Kim; Min Joung Lee; Bo Sang Kwon; Sang In Khwarg

doi:10.3341/jkos.2010.51.11.1513

Journal List > J Korean Ophthalmol Soc > v.51(11) > 1008692

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Lee, Choung, Kim, Lee, Kwon, and Khwarg: A Case of Periorbital Infantile Capillary Hemangioma Treated With Propranolol

Original Article

J Korean Ophthalmol Soc 2010;51(11):1513-1519.

Published online: 7 September 2010

DOI: https://doi.org/10.3341/jkos.2010.51.11.1513

A Case of Periorbital Infantile Capillary Hemangioma Treated With Propranolol

Eun Kyoung Lee, MD^1,², Ho-Kyung Choung, MD^1,³, Nam Ju Kim, MD^1,⁴, Min Joung Lee, MD^1,², Bo Sang Kwon, MD⁵, Sang In Khwarg, MD^1,²

¹Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea

²Seoul Artificial Eye Center, Seoul National University Hospital Clinical Research Institute, Seoul, Korea

³Department of Ophthalmology, Seoul National University Boramae Hospital, Seoul, Korea

⁴Department of Ophthalmology, Seoul National University Bundang Hospital, Seongnam, Korea

⁵Department of Pediatrics, Seoul National University Boramae Hospital, Seoul, Korea

Address reprint requests to Ho-Kyung Choung, MD Department of Ophthalmology, Seoul National University Boramae Hospital #39, Boramae-gil, Dongjak-gu, Seoul 156-707, Korea Tel: 82-2-870-2412, Fax: 82-2-831-0714, E-mail: hokyung@medimail.co.kr

Received 14 July 2010 Accepted 24 September 2010

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To report a case of periorbital infantile capillary hemangioma treated with propranolol.

Case summary

A 6-month-old girl visited our clinic for a mass on the right upper eyelid, which had been present since birth. A dome-shaped, red-purple colored mass occupying almost the entire right upper eyelid was observed, and over-lying branch-shaped telangiectases were also detected. The visual axis of the right eye was partially obscured, due to the ptotic eyelid, and her ability to fix and follow was poor in the right eye. The patient was diagnosed with infantile capillary hemagioma. Because amblyopia in her right eye was suspected, treatment with propranolol was initiated. After 2.5 months of propranolol treatment, the hemangioma decreased in size and volume dramatically, changed from red-purple to light red color, and softened. The ptosis of the right upper eyelid improved, as well as the ability of the right eye to fix and follow. No significant adverse effects (e.g. hypotension, bradycardia, hypoglycemia, bronchospasm, or elevated liver enzymes) were observed, except transient QTc prolongation during cotreatment with ibuprofen, due to an upper respiratory infection.

Conclusions

Propranolol should be considered as a treatment option for periorbital infantile capillary hemangioma. Further clinical studies are required to establish the optimal guidelines and long-term outcome.

Keywords: Hemangioma of infancy, Infantile capillary hemangioma, Periorbital hemangioma, Propranolol

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Figure 1.

Clinical photographs. (A&B) At the first visit, a large red-purple colored mass occupying almost entire right upper eyelid was noted. The visual axis of the right eye was partially obscured by the ptotic eyelid resulting from the mass. Relatively well circumscribed dome-shaped mass with rubbery consistency was located in the subcutaneous tissue of the right upper eyelid. Telangiectases and large superficial veins were also found. (C&D) After 1 week of propranolol treatment, the mass softened, and its color changed from red-purple to light red. (E&F) After 3 weeks of treatment, the hemangioma showed decrease in size and volume. The visual axis was no longer obscured. (G&H) After 11 weeks of treatment, the ptosis of the right upper eyelid improved, and symmetry of both eyelids' level was attained. The hemangioma flattened, softened and faded in color dramatically.

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