Hemangioma

Capillary hemangiomas are benign tumors that appear on the eyelids at birth. They are observed around the eye orbit and are more common in girls than boys. They are three times more common in women than in men. They can be large or small, and typically are found around the upper eyelid.

Pathological considerations

A capillary hemangioma is an abnormally large growth of blood vessel tissue. These lesions are composed of endothelial cells and blood vessels. Early growths have more cells, while more advanced growths have many lobular capillaries. As they grow, the capillary walls become thicker and more fibrous, which leads to vessel occlusion. Hemangiomas can be superficial on the skin; however, they can extend to the orbital cavity by means of the tissue beneath the eyelid.

Clinical signs and symptoms

Capillary hemangioma is also known as infantile hemangioma, juvenile hemangioma, or strawberry nevus of infancy. It is a common orbital benign tumor of childhood, and usually appears upon birth or within the first six months of life. Roughly a third of the cases are seen at birth, and over 90% are seen by 6 months. Cutaneous hemangioma involves just the skin and appears as red, elevated nodules. Subcutaneous lesions grow under the skin and are darker. Proptosis may occur if the orbit is impacted by the growth as the eyeball may protrude out. Hemangiomas on the upper eyelid push the eyelid downwards, causing ptosis (droopy lids.) Older patients may experience blurred vision caused by changes in corneal shape, astigmatism and squinting (strabismus). If one presses gently on a hemangioma, it can change color and have a softer, spongey texture.

Diagnosis

Diagnosis can be determined upon clinical observation. Other techniques to further characterize hemangioma include ultrasound to determine depth, CT scan to determine blood flow into the growth, and MRIs.

Treatment

While capillary hemangiomas tend to grow in their initial phase, they typically regress by the age of eight. If a patient developed visual impairment or infection, intervention may be necessary. This involves a steroid course that should not be long term. Steroid injections can lead to osteoporosis and weight gain, and can even impact blood flow to the retina and skin. Treatments that alter body immunity have also been used with limited success and some adverse effects. Propranolol, a beta blocker, is a relatively new treatment to help reverse visual problems with hemangiomas. This drug reduces growth factors that stimulate hemangiomas, by lessening blood supply and causing cell death within the growth (contraindicated for asthma patients). Surgical options include laser treatment or complete removal for deeper hemangiomas. Stopping blood supply through embolization can also be effective.

Conclusion

Capillary hemangiomas are the most common benign tumor of the orbit, especially for children. Non-surgical treatments are somewhat limited. Surgery appears to be the better option when compared to other medical therapies.