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Deep Periocular Infantile Capillary Hemangiomas Responding to Topical Application of Timolol Maleate, 0.5%, Drops

Kanmin Xue, BA, MBBChir, PhD1; Göran Darius Hildebrand, MD, FRCS, FRCOphth1
[+] Author Affiliations
1Pediatric Ophthalmology Service, Prince Charles Eye Unit, King Edward VII Hospital, Windsor, and Royal Berkshire NHS Foundation Trust, Reading, England
JAMA Ophthalmol. 2013;131(9):1246-1248. doi:10.1001/jamaophthalmol.2013.4171.
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Oral propranolol hydrochloride is widely used as first-line therapy for periocular infantile capillary hemangiomas. Close monitoring is required as potentially serious adverse effects are well recognized. Recently, the topical β-antagonist timolol maleate has also been reported to be an effective treatment for superficial infantile hemangiomas (IHs). As a result, a general paradigm has emerged that topical timolol may be a good option for superficial IH, while systemic propranolol remains the treatment of choice for deep IH. We describe 2 infants with deep periocular IHs who have undergone successful primary monotherapy with topical timolol maleate, 0.5%, drops. In both cases, topical treatment alone led to near-complete involution of the IH, and the effect has been well sustained following tapering or cessation of treatment.

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Figure 1.
Case 1

A, A 7-week-old girl had a rapidly growing, deep left upper eyelid capillary hemangioma causing eyelid closure and obstruction of the visual axis. B, After 1 week of topical treatment with timolol maleate, 0.5%, the lesion became paler, shrunk, and no longer obstructed the visual axis. C, After 10 months of topical timolol treatment, the lesion showed almost complete involution associated with resolution of amblyopia. D, No sign of recurrence was seen 4 months after stopping topical timolol treatment.

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Figure 2.
Case 2

A, A 6-month-old infant had a deep right lower eyelid capillary hemangioma causing deformation of the nose and restriction of adduction in depression of the right eye. B, Eleven months after topical treatment with timolol maleate, 0.5%, the swelling and discoloration have almost completely resolved and the nose is no longer deviated to the left.

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