Treatment of Infantile Capillary Hemangioma of the Eyelid with Systemic Propranolol

PURPOSE: To assess the efficacy and safety of systemic propranolol for infantile capillary hemangiomas of the eyelid. DESIGN: Prospective, interventional cases series. METHODS: All patients with eyelid infantile capillary hemangiomas at risk of developing amblyopia seen between January 2009 and January 2012 at the University Federico II, Naples, Italy, were treated with systemic propranolol (2 mg/kg body weight per day). Maximum length of treatment was 4 months, and propranolol was suspended when complete regression of lesions was obtained or in case of collateral effects. Minimum follow-up was 6 months. RESULTS: Of 17 patients with eyelid infantile capillary hemangiomas, 3 were excluded for asthma and 14 (7 males, 7 females; mean age, 20.85 +/- 29.7 months; range, 1 to 72 months) underwent treatment with systemic propranolol. Capillary hemangiomas involved the upper eyelid in 10 cases and the lower eyelid in 4 cases. Propranolol was stopped in 1 case for hypotension and in 1 case for allergy. Treatment was administered over a mean of 2.5 +/- 1.3 months (range, 1 to 4 months); the mean follow-up was 10.64 +/- 8.7 months (range, 6 to 39 months). Ten patients were younger than 1 year and demonstrated complete regression. Two patients older than 5 years also benefited from treatment. In 4 cases, amblyogenic astigmatism was present and decreased from 1.25 +/- 0.5 diopters before treatment to 0.25 +/- 0.2 diopters after treatment. No regrowth was observed. CONCLUSIONS: Four months of treatment with oral propranolol for eyelid infantile capillary hemangiomas led to complete regression of the lesion in patients younger than 1 year. No major collateral effects were observed. Treatment also may be considered in patients older than 5 years to reduce astigmatism and for aesthetic purposes. (Am J Ophthalmol 2013;155:165-170. (C) 2013 by Elsevier Inc. All rights reserved.)