Giant Eyelid Hemangioma With Ulceration

Two-month-old male baby presented with history of rapidly growing mass right eye of 6 weeks duration, was treated with oral steroids, intravenous antibiotics, and oral propranolol before presenting to us. On examination, large hemangioma measuring 7 × 6 cm involving both upper and lower eyelids with extensions into frontal, maxillary, and preauricular area with complete mechanical ptosis, areas of necrosis was noted (Fig. 1). The right globe was not visualized. Left eye was normal. Direct and indirect pupillary reactions were normal. CT scan done elsewhere confirmed the diagnosis and ruled out orbital involvement. The child was advised surgical debulking with maternal skin graft under general anesthesia. While awaiting surgery, the child was continued on oral propranolol in a maximum dose of 2 mg/kg/day in 2 divided doses, topical broad spectrum antibiotics, and daily saline dressing. Topical timolol gel (2%) was added twice daily. At 2 weeks review, gradual sloughing of necrotic tissue was noted (Fig. 2). At 6 weeks follow up, near total regression of hemangioma was noted. The child could open the eyelids and visual axis was clear (Fig. 3). There was ectropion of both upper and lower eyelids with minimal lagophthalmos. Eyelid can be a rare site for giant capillary hemangioma. Management of ulcerated giant hemangioma poses a therapeutic challenge. B blockers will help in the fast resolution of ulcerated hemangiomas by decreasing the production of vascular endothelial growth factor and fibroblast growth factor leading to prevention of functional and cosmetic deficits.The other differential diagnosis of thrombosed varix is very unlikely considering the age and the near-total resolution of the lesion.

FIG. 1.: Clinical picture at presentation.

FIG. 2.: Clinical picture at 2 weeks review-Gradual sloughing of necrotic tissue.

FIG. 3.: Near total regression of the lesion at 6 weeks follow up.