Every paediatric ophthalmology practice cares for infants and young children with periorbital haemangioma, and yet there is very little evidence based research to guide treatment. Options for management generally include topical, intralesional or systemic steroids, surgical resection, or no treatment at all, as haemangioma usually involute after a period of growth. When tumours block the visual axis, aggressive intervention is mandatory. In almost every other case, management is based on anecdote and clinical judgment and, in many cases, is optional or elective.

The aetiology of periocular haemangioma is also debated. Current opinion holds that haemangiomas occur more frequently in premature infants, yet older research on this subject suggests that this finding is caused by ascertainment bias—that is, premature infants are observed more often than full term infants, leading observers to conclude that premature infants develop haemangioma more commonly.^1,2 Why do haemangioma have a predilection for areas around the eyes, or do they? The astigmatism seen with periocular haemangioma is usually attributed to pressure effect of the tumour, but is there evidence to support this conclusion, or to validate that this is always the cause of astigmatism? Why does astigmatism often persist after the tumour regresses? Which locations for tumours …