Extensive Infantile Facial And Orbital Capillary Hemangioma: A Dramatic Regression Following Systemic Propanolol

Ismail Shatriah^1,3,Norazizah Mohd Amin¹, Wan Hazabbah Wan Hitam¹, Rohaizan Yunus², Leo Seo Wei³

¹Department of Ophthalmology, ²Department of Radiology, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia.
³Paediatric Ophthalmology and Strabismus Unit, Department of Ophthalmology, Tan Tock Seng Hospital, Singapore.

Purpose: To report a successful clinical outcome in a case of extensive infantile capillary hemangioma involving the right face and eye who was treated with systemic propranolol.

Methods: A case report

Results: A 2-month-old female infant presented with a plaque-like, indurated lesion over the right facial region. The lesion was first noted by parents 2 weeks after delivery. It progressed rapidly over one month and extended temporally and backward to the cheek, ear, scalp and neck. She could not open the right eye due to massive lesion involving the eyelids. Subsequently, she developed secondary increased intraocular pressure in the affected eye. CT-scan orbit and brain showed the lesion has extended to the right orbital region, traversing the optic canal with bulging of the right cavernous
sinus. She was treated with syrup propanolol at the age of 3-month old and showed a dramatic clinical regression. The dose was tapered down slowly and terminated after 9 months of therapy. The lesions are flattening now. She is currently able to open her eyes spontaneously and her intraocular pressure is within controlled. She is no longer on antiglaucoma drops.

Conclusions: Propanolol is an effective modality of treatment in extensive infantile capillary hemangioma, especially when ambylopia and glaucoma are the major concerns. It gives a rapid and remarkable clinical improvement. However, more clinical data are necessary to ensure long term efficacy and safety of this new treatment.