Corticosteroid treatment of periorbital haemangioma of infancy: a review of the evidence

Aim: To systematically review the literature for corticosteroid treatment of periorbital haemangioma of infancy ( HOI) and determine the relative efficacy and safety of oral, topical and intralesional corticosteroids. Methods: PubMed and the Cochrane Library were queried using keywords, and further articles were obtained by reviewing bibliographies. Inclusion and exclusion criteria were applied to create a subset of literature for analysis. Results: Systematic review revealed 81 original reports of periorbital HOI cases treated with steroids. Most studies and case series failed to document refractive error or visual acuity before and after treatment. Of cases meeting inclusion criteria, five patients received topical steroids and 25 patients received intralesional steroids. Patients receiving intralesional injections tended to demonstrate reduced astigmatism at follow up after treatment ( 21 of 28). The lack of studies with relevant objective ophthalmological end points prevented statistical meta- analysis. Conclusion: Intralesional injections may reduce refractive error, while the efficacy of topical steroids is unclear. Studies measuring objective ophthalmic data before and after treatment are sparse, and more studies are needed to determine the relative efficacy of different steroids. There are insufficient data to estimate the incidence of steroid side effects in patients treated with steroids for periorbital HOI or complications of intralesional injections in particular.