Haemangioma

Congenital, fast growing vessels of the orbit and the eyelid(s).

Congenital haemangioma are embryonic tumours.

Approx. 2-3 % of all neonates and approx. 10 % of all premature infants have haemangioma. Haemangioma are mostly quite small at birth, but about 10% of these haemangioma grow significantly within the first year of life. 90 % of these cases lead to a spontaneous regression of the abnormal vessels until the end of the second year of life and a complete healing takes place.

Histological there are different types of hemangioma with different clinical progression: e.g. capillary hemangioma, cavernous hemangioma etc.. They can occur at all vascularized vital parts.

If they occur in the region of the eyelids or the orbits, they are discovered by chance during other examinations or if their parts range to the skin of the lids. In dependence of their growth and their clinical progress, they ought to be controlled carefully and frequently. Controls of the progress can be made by ultrasound.

If the localisation is deeper within the orbit or if one has to decide whether surgery is necessary, a MRI with contrast agent is helpful. If there is not a spontaneous regression or if clinical or functional deficits appear, a therapy should be started instantaneously before irreversible damages occur.

The following complication of hemagioma of the eyelids and of the orbit postulates a direct therapy:

Increasing ptosis with restriction of the field of view
Increasing amblyopia, e.g. by choroideal folds
Exophthalmus (protrusion of the eye out of the orbit)
Diplopic images by restriction of motility of the respective eye
Ocular hypertension (glaucoma)
Etc.

The aim is not to lose track of hemangioma of the lids and the orbit during their growth phase, for being able to intervene early if complications are possible.

The different possibilities of therapy have to be chosen in dependence of localisation, depth and complications :

Cryo-application
Laser destruction
Medicamentous therapy
Surgical resection
Combination of these methods

All possible alternatives should be weighed up carefully, depending on the constellation of the clinical findings and the patient. The therapy should be performed at a specialized (oculoplastic) centre at the right time.