Background

Periorbital hemangiomas present in various forms, from a well-localized to more extensive tumor. Often, simple observation is all that may be required, however, lesions in the periorbital region can result in irreversible amblyopia secondary to obstruction of the visual axis, optic nerve compression, strabismus, or most commonly, astigmatism and anisometropia from corneal deformation. A variety of nonsurgical and surgical methods to manage these lesions have been proposed.

Methods

We reviewed all patients with periorbital hemangiomas managed by surgical excision at Children's Hospital of Michigan and Children's Hospital Boston. Indications for surgical excision were a well-localized lesion causing obstruction of the visual axis or corneal deformation, and greater than two diopters of astigmatism. Surgical technique involved excision or debulking of the hemangioma, and if necessary, reinsertion or advancement of the levator palpebrae superioris muscle. Inclusion criteria for review included patients treated surgically with a minimum six-month follow-up interval, and complete pre-operative and post-operative ophthalmologic assessments.

Results

Twenty-six patients met the inclusion criteria, with a mean hemangioma onset age of 1.0 months and mean operative age of 5.9 months. The majority of hemangiomas were subcutaneous and located in the upper lid, causing astigmatism (mean 2.3 diopters) in 88% of patients or blepharoptosis with obstruction of the visual axis in 46% of patients. Prior treatment in 54% of patients included either intralesional or oral corticosteroids, and/or patching. Postoperatively, a statistically significant improvement in the degree of astigmatism (mean 0.93 diopters) was observed. Reinsertion or advancement of the levator palpebrae superioris was required in 31% of patients. The mean follow-up interval was 31 months and complications were at a minimum. One patient had a local recurrence, not significant to warrant re-excision, one patient had residual astigmatism, and two patients exhibited residual blepharoptosis.

Conclusions

To prevent potentially irreversible amblyopia in patients with periorbital hemangiomas, our results suggest surgical excision before ten months of age to be efficacious, with infrequent complications, and significant improvement in the amount of astigmatism. We advocate resection for well-localized periorbital hemangiomas, causing major refractive error and likelihood for the development of potentially irreversible amblyopia, preferring to avoid in the majority of instances, intalesional corticosteroid injection, with its well-documented complication profile.
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