Congenital Capillary Haemangioma of Eyelid

Congenital Capillary haemangioma of eyelid (strawberry naevus) is a common vascular hamartoma in infants/children and is derived from endothelial rests.

Periorbital haemangioma may present as

  • Superficial cutaneous lesion (strawberry haemangioma)
  • Subcutaneous lesion
  • Deep orbital tumour
  • A combination of above mentioned locations.

About one-third of lesions are seen at birth and the remaining lesions are apparent by six months of age.

There is an initial phase of rapid growth followed by a period of dormancy and subsequently spontaneous involution over the years. Majority regresses to some extent by seven to nine years of age. It is more common in girls as compared to boys.

 

References

Shields Jerry A, Shields Carol L. Eyelid, Conjunctival, and Orbital Tumors- An Atlas and Textbook Second Edition. Lippincott Williams & Wilkins, a Wolters Kluwer business 2008. P 132- 139.

Dutton Jonathan J, Gayre Gregg S, Proia Alan D. Diagnostic Atlas of Common Eyelid Diseases. Taylor & Francis Group, LLC 2007. P 126- 128.

Bloom HJG, Lemerle J, Neidhardt MK, Voûte PA. Cancer in Children- Clinical Management, International Union Against Cancer. Springer- Verlag Berlin- Heidelberg 1975. P 134- 135.

Byrne James Vincent. Tutorials in Endovascular Neurosurgery and Interventional Neuroradiology Second Edition. Springer International Publishing, AG 2017. P 290.

Giele Henk, Cassell Oliver. Plastic and Reconstructive Surgery. Oxford University Press 2008. P 459- 460.

http://eyewiki.aao.org/Capillary_Hemangioma

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4901851/

https://emedicine.medscape.com/article/1083849-overview

https://aapos.org/terms/conditions/30

http://www.ijo.in/article.asp?issn=0301-4738;year=2017;volume=65;issue=11;spage=1221;epage=1223;aulast=Padmanaban

Congenital capillary haemangioma may present as

  • Flat red coloured lesion with telangiectatic blood vessels
  • Enlarged lesions become elevated, red, dome shaped mass with soft consistency
  • Subcutaneous lesions present as a bluish-purple mass
  • Involuted haemangiomas are pale pink in colour or have white mottled appearance due to fibrosis

Congenital capillary haemangioma, one of the common orbital tumour in children, represents a vascular hamartoma derived from endothelial rests.

About one-third of lesions are seen at birth and the remaining lesions are apparent by six months of age.

Clinically, superficial congenital capillary haemangiomas initially present as a red flat lesion with telangiectatic blood vessels. When enlarged, they become elevated, red, dome shaped mass having soft consistency. The masses are compressible and blanch with pressure.

Subcutaneous lesions present as bluish-purple mass. Like superficial lesions, it is also soft and spongy in consistency. On crying or with Valsalva manoeuvre, haemangiomas enlarge and are darkened in colour as they get filled with blood.

Involuted haemangiomas develop pale pink colour or give white mottled appearance due to fibrosis. These do not blach on pressure.

 

Histopathology

Congenital capillary haemangiomas are composed of thin walled capillaries. This is lobulated and is separated by septa. The masses are well circumscribed by fibrous tissue. The capillaries may be lined by flattened endothelium and contain erythrocytes.

 

Investigations

Following investigations may aid in diagnosis

  • Computed tomography
  • Magnetic resonance imaging
  • Ultrasound.


Differential diagnosis

Congenital capillary haemangioma should be differentiated from

  • Naevus flammeus
  • Lymphangioma
  • Cavernous haemangioma
  • Encephalocoele
  • Rhabdomyosarcoma
  • Inflammatory swellings
  • Neuroblastoma.
  • Dermoid cyst (orbital dermoid)

 

Conservative management

Most congenital capillary haemangiomas undergo spontaneous regression. Therefore, conservative observation is appropriate.

Intervention is done in patients who develop functional limitations

  • Affecting eyelids
  • Amblyopia
  • Astigmatism due to pressure on cornea through eyelids

 

Medical therapy

  • Corticosteroids: Systemic or intralesional corticosteroids produce dramatic reduction in size of the lesion. This treatment may require repetition. This should be given under medical supervision.
  • Laser treatment: This may be required in select cases.
  • Radiotherapy: Radiotherapy may be tried, but it carries the risk of secondary orbital tumours.

 

Surgical therapy

This may be advocated in select localised lesions.

In some cases, residual part of the tumour may be left behind to avoid damage to the eyelid structures.

The most significant ocular complication is amblyopia, which may result due to occlusion of the visual axis or from anisometropia due to pressure induced astigmatism.

  • PUBLISHED DATE : Jan 24, 2018
  • PUBLISHED BY : NHP Admin
  • CREATED / VALIDATED BY : Dr. S. C. Gupta
  • LAST UPDATED ON : Jan 24, 2018

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