Aim To assess the efficacy of systemic propranolol for severe capillary haemangiomas involving eyelid and orbit.
Method This was a longitudinal retrospective study that began in November 2007, involving eight children with disfiguring orbit and eyelid capillary haemangioma who received oral propranolol therapy. Three patients with life-threatening haemangiomas spreading to the orbit were first treated with systemic corticosteroids and beta-adrenergenic blocking agents. The remaining five patients with functional visual impairment received propranolol only. All children were given propranolol at a dose of 2 mg/kg body weight per day. The treatment was initiated between 2 and 36 months of age, with a follow-up period ranging from 6 to 30 months. Beta-blocking agents were used for 3–10 months.
Results We observed a successful 100% regression: that is, clinical regression by flattening 24 h after the start of treatment, regression on colour Doppler ultrasound imaging with an increase in resistance index of blood vessels, or regression seen on MRI. No re-growth was observed after the trial ended.
Conclusion Despite their self-limiting course, infantile orbital and eyelid haemangiomas can cause visual impairment or disfigurement. Corticosteroids are used as first-line therapeutic agents for problematic infantile haemangiomas. Other options include interferon-α and vincristine, which present problematic side effects. In our series, propranolol was shown to inhibit haemangioma tumour growth with a better benefit/risk ratio. In the absence of any randomised study comparing the effects of systemic corticosteroids and propranolol, we propose that beta-blockers could be used as first-line therapy for severe periocular haemangiomas.
- infantile haemangioma
- eye (globe)
- child health (paediatrics)
- treatment other
- ocular surface
- clinical trial
- experimental and laboratory
- treatment medical
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Oral presentation at SFO congress, Paris, May 2009, and SOPREF congress, Paris, May 2009
Competing interests None.
Patient consent Obtained.
Ethics approval Ethics committee CHU de Bordeaux.
Provenance and peer review Not commissioned; externally peer reviewed.