Surgical treatment of periocular hemangiomas: a single-center experience

At Great Ormond Street Hospital for Children, patients with periocular hemangiomas are assessed in a multidisciplinary team setting using a protocol developed in 1999. As part of this protocol, surgery is indicated for lesions that continue to cause amblyopia despite treatment with systemic or intralesional steroids or both. Surgery is performed by one of the authors (D.D.). This experience is described.

A retrospective notes review was undertaken of surgically excised periocular hemangiomas.

Eighteen consecutive cases (15 girls and three boys) were identified as having surgical treatment over a 5-year period. The mean age at the time of surgery was 22 months (range, 5 months to 3 years). All but one of the patients had amblyopia or a threat to normal visual development. The follow-up ranged from 1 month to 4 years. Three were lower lid lesions and 15 were upper lid lesions. When there was a threat to normal visual development, preoperative imaging by ultrasound, magnetic resonance imaging, or contrast computed tomography was performed. No rebound growth or deterioration in visual development occurred in this group of patients.

There is limited experience in the literature of excisional surgery for the treatment of periocular hemangiomas. The authors present a series of 18 patients who have been treated at Great Ormond Street Hospital for Children after either failed medical therapies or after patient request. With the appropriate indications and surgical principles, periocular hemangiomas in children can be safely and effectively excised.