To evaluate the effect of systemic propranolol therapy on periocular infantile capillary hemangioma.

In an interventional prospective case series, patients younger than 24 months with previously untreated vision-threatening or severely disfiguring periocular capillary hemangioma who presented to our institution in 2013 were enrolled. Comprehensive ophthalmic examination was performed, including evaluation of ptosis, amblyopia and cycloplegic refraction. CT scan or MRI was performed to establish diagnosis and assess size and extent of the lesion. Treatment was initiated with daily dose of 0.5 mg/kg oral propranolol and gradually increased to 2 mg/kg daily, continued for 6 months. Follow up visits were performed at one week after initial therapy, and monthly thereafter until 6 months after the end of treatment. In each follow up visit we evaluated side effects and response to treatment, graded according to the decrease in size and color intensity of the lesion as ‘complete’ if it decreased >75%, ‘incomplete’ if it decreased 50-75%,’intermediate’ if it decreased 25-50%, and ‘non-responsive’ if there was <25% decrease.

Thirty-two eyes of 30 patients (25 females and 5 males) with periocular capillary hemangioma were included. Age range was 1.5 to 18 months (mean 4.5 months). In five patients (16.7%) orbital extension of the lesion was evident in imaging. Response to treatment was complete in 27 patients (29 eyes; 90%), incomplete in two case (6.7%) and intermediate in one patient (3.3%). Amblyopia, present in 8 cases (26.7%) in the first visit, persisted in only one case (3.3%) at the conclusion of treatment. None of our patients experienced adverse effects necessitating cessation of therapy.

Considering the favorable response and safety of systemic propranolol, we recommend it as an effective first line therapy for periocular capillary hemangioma in infants.