ISSN 0972-0200

Brief Communication

Infantile Periocular Capillary Hemangioma

An Unusual Presentation
Karma L Bhutia,1 Amit Gupta2
Sikkim Manipal Institue of Medical Sciences, Gangtok, Sikkim, India
1

2
Centre For Sight Hospital, Malviya Nagar, Jaipur, Rajasthan

Summary
A 22 days old infant presented with a large capillary hemangioma
involving the right lower eyelid causing a total occlusion of the visual
axis. The treatment given was a single intralesional triamcinolone
acetonide injection (0.4 mg), followed a month later with systemic
steroids (4mg) for 6 weeks. After 6 weeks, there was a significant
reduction in the size of the mass resulting in clearing of the
visual axis. We herein report a large infantile periocular capillary
hemangioma which was successfully managed with a single injection
of intralesional and systemic corticosteroids together.
Keywords: periocular capillary

Dear Editor,
Capillary hemangiomas are the most common eyelid and
orbital tumours of childhood.1 Around 1 in 10 children are
affected by capillary hemangioma. Male to female ratio is
1:3. Most of the capillary hemangiomas can be diagnosed
clinically on examination, but occasionally the identification
may require a use of Ultrasonography, Computerized
Tomography or Magnetic Resonance Imaging for accurate
diagnosis. They usually present as a small isolated lesions
for which observation is the rule, as spontaneous involution
without sequelae is seen in majority of the cases. In some
cases they present as a large mass that can cause stimulus
deprivation amblyopia. Herein, we report a case of such
large infantile periocular capillary hemangioma of right eye
lower lid.
Case Report
A 22 days old female infant presented with a swelling of
right eye lower eyelid covering the right visual axis. The
mass was reported to be present since birth, which gradually
increased in size over the next few days. On examination,
the right lower eyelid revealed a well-defined, nodular
mass measuring 3.5 x 2.2 x 2cm in size. The mass involved
the entire lower eyelid and the overlying skin had reddish
discolouration (Figure 1). The mass was soft in consistency,
non- pulsatile, non- reducible and blanched on pressure.
The size increased on crying and no bruit was present.
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DOI
http://dx.doi.org/10.7869/djo.157
Figure 1: Pre-treatment photograph of a twenty two days
old infant with total right eye occlusion
The anterior and posterior segment examination was
normal. The left eye was normal. The blood investigations
were normal. Magnetic resonance imaging (MRI) of right
orbit showed a soft tissue mass measuring 3.5cm x 1.5cm
x 2.2cm in preseptal region of right orbit and involving
the right lower eyelid with no intra-orbital or intracranial
extension and suggested the possibility of capillary
hemangioma (Figure 2). The treatment was started with a
single intralesional injection of Triamcinolone Acetonide
(0.4mg in 0.1ml) followed a month later with oral steroid
(Prednisolone Sodium Phosphate 1mg/kg body weight)
drops for 6wks with the dose tapered in the last 2 weeks.
After 6 weeks of treatment, there was a significant reduction
in the size of the lesion resulting in clearing of visual axis
(Figure 3). At 10 months of follow up visit, the patient had
no recurrence of the lesion and clear visual axis.
Discussion
The case presented herein shows a large tumour of the
lower eyelid in a 22 days old female infant. These tumors
present as tiny red, strawberry sized spots.1 Capillary
hemangiomas typically undergo a “proliferative” phase of
growth within 3-6 months of initial appearance.2 However
in our case, within few days of birth it underwent rapid
growth and on presentation, it covered the visual axis.
Though spontaneous involution is the rule in majority of
the cases, this tumour required an immediate intervention
due to the risk of stimulus deprivation amblyopia.
Stigmar et al reported 4 out of 51 patients who developed
moderate to severe amblyopia after 1 month of occlusion

Del J Ophthalmol - Vol 26 No: 2 October-December 2015

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E-ISSN 2454-2784
Brief Communication

the success of systemic steroids in cavernous hemangioma.7

The dose of oral steroid commonly used is 1-2 mg/kg daily.
We also used the same dose protocol. The combination of
intralesional and oral steroids in our case worked as an
effective modality in reducing the size of the lesion and
clearing the visual axis.
Conclusion
Intralesional and systemic corticosteroid can still be used
as the first line therapy for treating infantile periocular
capillary hemangioma.

Cite This Article as: Bhutia K, Gupta A. Infantile Periocular Capillary

Hemangioma – An unusual presentation. Delhi J Ophthalmol 2015;26:150-1.

Acknowledgements: None

Date of Submission: 14.7.2015 Date of Acceptance: 3.9.2015

Conflict of interest: None declared

Figure 2: Magnetic resonance imaging FLAIR T2 image showing a hyper
intense soft tissue mass in preseptal region of right orbit suggestive of
capillary hemangioma of lid
Figure 3: Clinical photograph after six weeks of treatment shows
significant decrease in the tumour size with a clear visual axis of right eye
of eye in their case series.3 Case reviews have reported 40
to 60% incidence of amblyopia with periocular capillary
hemangioma.2,3 Schwartz et al performed the largest review
and studied the risk factors for amblyopia.4 They suggested
that a hemangioma size greater than 1cm in diameter is an
important predictor of amblyogenesis and approximately
50% of such patients developed amblyopia. Considering
the size of our tumor (3.5cm) we started treatment with an
intralesional steroid followed by systemic steroids. Kushner
et al reported a case series of periocular hemangioma, where
successful treatment was noted with the use of intralesional
steroids in 3 out of 4 patients.5 A study of the American
Association for Paediatric Ophthalmology members,
reported that intralesional steroid injection was the most
common initial therapy.6 Zarem and Edgerton first reported
Source of Funding: Nil
References
1. Haik BG, Karcioglu ZA, Gordon RA, Pechous BP. Capillary
hemangioma (infantile periocular hemangioma). Surv
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2. Haik BG, Jakobiec FA, Ellsworth RM, Jones IS. Capillary
hemangioma of the lids and orbit: an analysis of the clinical
features and therapeutic results in 101cases. Ophthalmology
1979; 86:760-92.
3. Stigmar G, Crawford JS, Ward CM, Thomson HG. Ophthalmic
sequelae of infantile hemangiomas of the eyelids and orbit. Am
J Ophthalmol 1978; 85:806-13.
4. Schwartz SR, Blei F, Ceisler E, Steele M, Furlan L, Kodsi S. Risk
factors for amblyopia in children with capillary hemangiomas
of the eyelids and orbit. J AAPOS 2006; 10:262-8.
5. Kushner BJ. Local steroid therapy in adnexal hemangioma.
Ann Ophthalmol 1979; 11:1005-9.
6. Wasserman BN, Medow NB, Homa-Palladino M, Hoehn ME.
Treatment of periocular capillary hemangiomas. J AAPOS
2004; 8:175-81.
7. Zarem HA, Edgerton MT. Induced resolution of cavernous
hemangiomas following prednisolone therapy. Plast Reconstr
Surg 1967; 39:76-83.
Corresponding author:
Karma L Bhutia MS
Sikkim Manipal Institue of Medical Sciences,
Gangtok, Sikkim, India
Email: drkarma07@gmail.com

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