Periocular hemangiomas in childhood--functional and esthetic results

Hemangiomas are the most common tumors of the eyelids and orbit in childhood. These tumors can produce ptosis, strabismus and anisometropia, resulting in amblyopia. The treatment of hemangiomas is a challenge with respect to the functional results (prevention of amblyopia) and cosmetic outcome.

The history, clinical findings, magnetic resonance imaging (MRI), management and outcome of 15 children (3-9 months old) with hemangiomas of the eyelids and/or orbital involvement are reviewed.

Seven patients with small superficial hemangiomas were merely kept under clinical observation. In seven other patients with threatened or existing occlusion of the visual axis or refractive errors, treatment was indicated. Four children were given local Neodymium: YAG-laser therapy. In patients with large subcutaneous eyelid hemangiomas and involvement of the orbita we decided to treat with interstitial Neodymium: YAG-laser therapy in combination with systemic corticosteroids. One patient with an unknown tumor in the medial canthus was diagnosed by biopsy. During the follow-up period of 12-24 months, all untreated patients and 6 of 7 treated children showed involution of their tumors. One patient with a large eyelid and orbital hemangioma with occlusion of the visual axis did not respond to laser therapy and systemic corticosteroids; excision of the tumor was necessary. All children with eyelid hemangiomas with orbital involvement (n = 3) suffered from anisometropia with astigmatism and were treated for amblyopia. During 24 months of amblyopia treatment, the visual acuity improved in two of three cases to 0.4 and 1.0.

Periorbital hemangiomas must be managed by individual and interdisciplinary diagnostic and therapeutic approaches. Therapy of amblyopia remains mandatory in all cases of large eyelid hemangiomas and/or orbital involvement.