Capillary Hemangioma

Capillary Hemangioma
SYMPTOMS Typically asymptomatic but can experience diplopia and/or reduced vision (amblyopia) due to induced astigmatic anisometropia
SIGNS Red, raised appearance if capillary hemangioma is superficial or cutaneous.
Blue, deep appearance if capillary hemangioma is subcutaneous or extends into the orbit
Mechanical ptosis, Proptosis, Strabismus may also be present
WORK-UP Pupils, EOMs, Cover test, Ptosis evaluation, Exophthalmometry, Full eye exam
TREATMENT Usually a capillary hemangioma needs to be monitored and no treatment is indicated because typically there is enlargement of the capillary hemangioma during the first year with spontaneous regression the following years
40% of capillary hemangiomas completely involute by age 4 and 80% of capillary hemangiomas completely involute by age 8
Beta blockers (oral or topical) may help with regression (Oral Propranolol is the most common medication prescribed)
Rarely, surgical options such as laser photocoagulation or excision may be performed (Refer to an Oculoplastic specialist or Pediatric ophthalmologist if the capillary hemangioma is not regressing and/or the capillary hemangioma is causing diplopia, induced astigmatism, ptosis, proptosis, strabismus)
FOLLOW-UP See patient back in 6-12 months in order to monitor capillary hemangioma
Once the capillary hemangioma is treated by an oculoplastic specialist/pediatric ophthalmologist and the eye is stable, the patient should be seen back in 6-12 months
ADDITIONAL LAB | TESTS Typically none but a CT or MRI of the orbit may be needed for capillary hemangiomas in order to assess periorbital involvement and amount of orbital extension
Refer to PCP in order to rule out any potential syndromes associated with capillary hemangiomas: Kasabach-Merritt syndrome, Microangiopathic Hemolytic Anemia (MAHA), PHACE syndrome, Maffucci syndrome
ETIOLOGY Congenital hamartomas
DIFFERENTIAL DX Port-wine stain, Lymphangioma
NOTES Most common benign periorbital tumor in children
The most common location of a capillary hemangioma is on the upper eyelid
Capillary hemangiomas can change in color and enlarge when patient is crying
Capillary hemangiomas can blanch with pressure