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SYMPTOMS
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Typically asymptomatic but can experience diplopia and/or reduced vision (amblyopia) due to induced astigmatic anisometropia
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SIGNS
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Red, raised appearance if capillary hemangioma is superficial or cutaneous.
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Blue, deep appearance if capillary hemangioma is subcutaneous or extends into the orbit
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Mechanical ptosis, Proptosis, Strabismus may also be present
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WORK-UP
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Pupils, EOMs, Cover test, Ptosis evaluation, Exophthalmometry, Full eye exam
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TREATMENT
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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
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40% of capillary hemangiomas completely involute by age 4 and 80% of capillary hemangiomas completely involute by age 8
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Beta blockers (oral or topical) may help with regression (Oral Propranolol is the most common medication prescribed)
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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)
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FOLLOW-UP
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See patient back in 6-12 months in order to monitor capillary hemangioma
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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
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ADDITIONAL LAB | TESTS
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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
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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
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ETIOLOGY
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Congenital hamartomas
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DIFFERENTIAL DX
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Port-wine stain, Lymphangioma
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NOTES
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Most common benign periorbital tumor in children
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The most common location of a capillary hemangioma is on the upper eyelid
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Capillary hemangiomas can change in color and enlarge when patient is crying
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Capillary hemangiomas can blanch with pressure
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