Am Fam Physician. 1999;59(1):182-192
Capillary hemangiomas are the most common orbital tumors occurring in childhood. They are present in only 1 to 2 percent of newborns, but by one year of age, up to 10 percent of children have these tumors. Thirty-eight percent of affected children have lesions on the head and neck. Girls are more commonly affected than boys, and there is no racial, ethnic or regional predominance. In addition, no inheritance pattern is associated with this condition. Yap and colleagues reviewed the history, diagnosis and management of periocular capillary hemangiomas in infants.
Initially, superficial capillary hemangiomas appear as flat, circumscribed lesions. Within weeks, the lesions become raised, nodular and red. They are stable in size for about six months, then begin spontaneous involution during the child's second year of life. In 76 percent of children, involution is complete by seven years of age. However, lesions around the eyes, on the eyelids or in the orbit can cause strabismus or proptosis. These lesions require prompt treatment to prevent visual loss from amblyopia. Pressure from an eyelid hemangioma can permanently change the curvature of the eye, causing astigmatism.
Diagnosis of a superficial hemangioma is usually confirmed by inspection alone. Deep capillary hemangiomas may require imaging to distinguish them from other types of tumors and to ensure that they are not impinging on the optic nerve. In children with orbital hemangiomas, a thorough examination for associated lesions in the head or neck is required. Large capillary hemangiomas can ulcerate and become infected, or they can cause serious coagulopathies and hemolytic anemia, but these situations are rare.
Most patients with capillary hemangiomas require no treatment. Lesions that threaten a child's life or sight can be treated with corticosteroids. In most cases, oral prednisone can decrease tumor size within two weeks. However, when steroids are discontinued, rebound growth may occur. As a result, treatment with oral corticosteroids may often be continued for several months, and side effects may develop. Rather than continue treatment with systemic steroids, intralesional steroids are often preferred. Depending on the size of the tumor and the weight of the infant, 1 to 2 mL of a 50:50 mixture of 1 mL of triamcinolone (40 mg per mL) and 1 mL of betamethasone (6 mg per mL) can be injected into the lesion, under general anesthesia if necessary. Results are usually apparent after one week. A second injection can be given four to six weeks later, if necessary. Second-line treatments include surgical excision, radiation and interferon.