A capillary hemangioma (“strawberry” birthmark) is a non-cancerous tumor consisting of an abnormal overgrowth of tiny blood vessels. Capillary hemangiomas may not be present at birth but appear within the first 6 months of life. They usually begin to decrease in size between 12 and 15 months of age. Most regress nearly completely by 5 or 6 years of age. Capillary hemangiomas are more common in premature infants and in girls.
Capillary hemangiomas can be found anywhere on the body. Eye involvement includes eyelids, the eye surface called the conjunctiva, and the eye socket or orbit.
Capillary Hemangiomas of the eyelid can cause amblyopia (decreased vision) by two mechanisms. First, if the lesion exerts pressure on the surface of the eye, this causes astigmatism and the baby may develop refractive amblyopia. Alternatively, if the lesion causes the eyelid to droop significantly (ptosis), such that the pupil is blocked, this will result in occlusion amblyopia.
If amblyopia develops in the affected eye, it can be treated with glasses and/or occlusion therapy using patches or atropine drops.
A capillary hemangioma in the eye socket (the area around the eye called the orbit) can put pressure on the eye and result in amblyopia or strabismus. It can also press on the optic nerve which may cause optic nerve atrophy. Any of these conditions may damage vision.
No. Many capillary hemangiomas around the eye are simply monitored for the development of vision problems. If the vision is not affected, treatment is often not needed.
Capillary hemangiomas can be treated in a variety of ways depending on the location of the hemangioma, its severity, and whether or not it is causing vision problems.
Steroid medications are often used to treat hemangiomas. Steroids can stop the progression of hemangiomas by causing the blood vessels to shrink. Depending on the size and location of the hemangioma, steroids may be prescribed by mouth, injected directly into the hemangioma, or applied to the surface of the hemangioma. Steroid medications can have undesirable side effects including delayed physical growth, cataract, glaucoma and central retinal artery occlusion.
Propranolol is a medication that has recently been shown to be effective in treating hemangiomas with fewer side effects than steroids. Propranolol can be taken orally or can be applied topically if the hemangioma is very small and thin. Since propranolol can affect heart rate and blood pressure, careful monitoring at the beginning of treatment is sometimes required and may include a brief admission to the hospital.
Laser treatments can sometimes be used on superficial hemangiomas to prevent growth, diminish their size, or lighten their color.
Traditional surgery to remove hemangiomas around the eye is generally reserved for small, well-defined hemangiomas that are located under the skin surface.
Capillary hemangiomas typically take several years to regress. The involved skin may retain a red color or may be slightly puckered in appearance, or may look perfectly normal depending upon how completely the hemangioma resolves
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