Author Affiliations: The Institute of Ophthalmology and Visual Science, University of Medicine and Dentistry of New Jersey–New Jersey Medical School, Newark (Dr Guo); and Yale University School of Medicine, New Haven, Connecticut (Ms Ni).
The prevalence of periorbital or eyelid hemangioma ranges from 1% to 3%. There are more than 1.5 million affected children in the United States.1 Amblyopia is the most common complication of capillary hemangioma of the eyelid in children, with an incidence of 60%. If it is not treated promptly, it may lead to irreversible blindness in young children.2 The treatment options include corticosteroids, interferon alfa-2a, laser therapy, embolization, immunomodulators, surgery, and systemic propranolol.1,3,4 All therapeutic options are associated with adverse effects, some of which are serious. The treatment of a large capillary hemangioma on a child's left upper eyelid using topical β-blocker solution is reported. The hemangioma significantly improved within a few weeks of the topical treatment.
A 4-month-old girl had a large capillary hemangioma on her left upper eyelid that induced blepharoptosis and covered her pupil (Figure 1). Her right eye followed and fixated well, while the left eye was slow to fixate. She was orthophoric with full duction and version in all fields of gaze. Her ocular examination showed a normal anterior segment, optic nerve, and retina in both eyes. Her cycloplegic retinoscopy results were +3.50 − 1.50 × 180° OD and +4.50 − 3.75 × 180° OS with more than 2 diopters of induced astigmatic anisometropia. The child's mother was instructed to apply timolol maleate, 0.5%, ophthalmic solution twice daily, 2 drops onto the surface of the hemangioma with a gentle spread using a finger. The child was not receiving systemic medication and was followed up by her pediatrician during the treatment period. After 5 weeks of treatment, the hemangioma was significantly reduced in size, thickness, and color, clearing the visual axis (Figure 2). Topical β-blocker treatment was discontinued at 7 weeks and repeat retinoscopy results at 11 weeks improved to +4.00 − 1.50 × 180° OS. The child has been followed up for 4 months and tolerated the topical treatment well. No local or systemic adverse effects were noted.
Before topical treatment, a large capillary hemangioma involved the child's left upper eyelid, inducing mechanical blepharoptosis and covering her left pupil.
After a few weeks of treatment with topical β-blocker eyedrops, the hemangioma was significantly reduced in size, thickness, and color. The mechanical blepharoptosis also improved significantly, clearing the visual axis.
Capillary hemangioma is the most common benign tumor of the eyelid or orbit in children. It affects more than 2% of infants.3 Indications for treatment are amblyopia, compressive optic neuropathy, and exposure keratopathy.1,3 All current therapeutic options can be associated with systemic adverse effects. First-line therapy includes oral or intralesional corticosteroids. The complications of corticosteroid treatment include disfiguring eyelid changes, elevated intraocular pressure, central retinal artery occlusion, hypertension, and adrenal cortical insufficiency.1,3,5 Surgical excision can be complicated by hemorrhage and infection. Therapy with immunomodulators has been associated with myelosuppression and hepatotoxic effects (cyclophosphamide) and neurotoxic effects (interferon alfa-2a).3
Most recently, systemic application of propranolol was reported to successfully treat severe hemangioma in infants.4 However, oral application of propranolol can cause severe systemic complications. These include bronchospasm, vasospasm, hypoglycemia, hypotension, severe bradycardia, heart blockage, and congestive heart failure.6 Our case demonstrates that the application of topical β-blocker solution produced significant reduction of a large capillary hemangioma and resulted in the clearance of the child's visual axis within a few weeks of treatment. No local or systemic adverse effects were noted.
These results suggest that topical β-blocker administration provides a safe and effective alternative to systemic use in the treatment of capillary hemangioma. Our ongoing studies include a case series on the treatment of capillary hemangioma with topical β-blocker solution and a comparison of the efficacy and adverse effects of topical vs systemic β-blocker in the treatment of capillary hemangioma of the eyelid.
Correspondence: Dr Guo, The Institute of Ophthalmology and Visual Science, University of Medicine and Dentistry of New Jersey–New Jersey Medical School, 90 Bergen St, DOC 6100, Newark, NJ 07101 (email@example.com).
Financial Disclosure: None reported.
Thank you for submitting a comment on this article. It will be reviewed by JAMA Ophthalmology editors. You will be notified when your comment has been published. Comments should not exceed 500 words of text and 10 references.
Do not submit personal medical questions or information that could identify a specific patient, questions about a particular case, or general inquiries to an author. Only content that has not been published, posted, or submitted elsewhere should be submitted. By submitting this Comment, you and any coauthors transfer copyright to the journal if your Comment is posted.
* = Required Field
Disclosure of Any Conflicts of Interest*
Indicate all relevant conflicts of interest of each author below, including all relevant financial interests, activities, and relationships within the past 3 years including, but not limited to, employment, affiliation, grants or funding, consultancies, honoraria or payment, speakers’ bureaus, stock ownership or options, expert testimony, royalties, donation of medical equipment, or patents planned, pending, or issued. If all authors have none, check "No potential conflicts or relevant financial interests" in the box below. Please also indicate any funding received in support of this work. The information will be posted with your response.
Some tools below are only available to our subscribers or users with an online account.
Download citation file:
Web of Science® Times Cited: 49
Customize your page view by dragging & repositioning the boxes below.
The Rational Clinical Examination: Evidence-Based Clinical Diagnosis
All results at
Enter your username and email address. We'll send you a link to reset your password.
Enter your username and email address. We'll send instructions on how to reset your password to the email address we have on record.
Athens and Shibboleth are access management services that provide single sign-on to protected resources. They replace the multiple user names and passwords necessary to access subscription-based content with a single user name and password that can be entered once per session. It operates independently of a user's location or IP address. If your institution uses Athens or Shibboleth authentication, please contact your site administrator to receive your user name and password.