What are the implications of a hemangioma on the eye in a newborn?

From the Guidelines

Hemangiomas on a newborn's eye should be promptly evaluated by a pediatric ophthalmologist and considered for treatment with oral propranolol, typically started at 2-3 mg/kg/day, to prevent potential vision problems. The management of infantile hemangiomas has evolved, and according to the most recent clinical practice guideline for the management of infantile hemangiomas 1, early intervention and/or referral (ideally by 1 month of age) is recommended for infants who have potentially problematic IHs, such as those near the eye. Key considerations in the management of infantile hemangiomas include:

• The potential for vision problems, including astigmatism, amblyopia (lazy eye), or obstruction of vision
• The need for prompt evaluation by a pediatric ophthalmologist
• The use of oral propranolol as first-line therapy, typically started at 2-3 mg/kg/day divided into 2-3 doses for 6-12 months
• The importance of cardiac evaluation before starting propranolol
• Alternative treatments, such as topical timolol (0.5% solution applied twice daily), intralesional or systemic corticosteroids, or laser therapy in specific cases
• Regular follow-up appointments to monitor the hemangioma's growth and ensure normal visual development As noted in the American Academy of Pediatrics report on infantile hemangiomas 1, complications can include ulceration, bleeding, feeding problems, and visual impairment, and segmental hemangiomas are more likely to lead to complications. However, the most recent guideline 1 emphasizes the importance of early intervention and the use of propranolol as the drug of choice for systemic treatment, and this should guide clinical decision-making. Parents should be advised to watch for rapid growth of the lesion, ulceration, bleeding, or any changes in the child's vision or eye alignment, and to seek prompt medical attention if any of these occur.

From the Research

Hemangioma in Newborns on the Eye

• Hemangiomas are the most common benign tumor of infancy, and they can occur in the periocular region, which includes the area around the eye 2.
• Periocular hemangiomas require close evaluation and early treatment if they have the potential to threaten or permanently compromise vision 2.
• The natural course of infantile hemangiomas typically involves growth for up to a year, followed by regression without treatment over a period of years with no cosmetic or functional sequelae 3.
• However, infantile hemangiomas, particularly those involving the face or eye, may be disfiguring and result in lifelong sequelae, and therefore may require treatment 3.
• Treatment options for infantile hemangiomas include oral propranolol, topical timolol, and oral corticosteroids, as well as laser therapy and surgical excision in some cases 4, 5, 6, 3.
• The choice of treatment depends on the size, location, and severity of the hemangioma, as well as the patient's overall health and age 4, 6.
• Beta-blockers, such as propranolol, have become a mainstay of therapy for infantile hemangiomas due to their relatively low-risk profile and efficacy 5, 3.