A Rare Case Of Capillary Haemangioma Of Eyelid In A Child.

Dr. Sagar Chaudhari ( Ms Ophthalmology), Dr. Ashutosh Patil( Doms, Fgo), Dr. Rohini Waghmare ( Post Graduate Student)

1. Dr. Sagar Chaudhari ( MS Ophthalmology) Dr. Ashutosh Patil ( DOMS, FGO) Dr. Rohini Waghmare ( Post Graduate Student) A rare case of capillary haemangioma of eyelid in a child.

2. INTRODUCTION: Capillary hemangiomas are the most common benign tumors found in children more commonly in lid. These tumors show no pattern of inheritance from either parent , nor specific ethnic or national preference. 1 Capillary hemangiomas are caused by a proliferation of large, aggregated endothelial cells and anastomosing blood filled channels. Spontaneous resolution of the tumor is seen in many patients. Forty percent resolve by the time a child is four years old and 70% resolve by the age of seven. 2 Many infants are at risk for developing amblyopia , anisometropia and strabismus. 3

3. CASE REPORT: HISTORY A nine years old male child presented with a four-month history of non fluctuating swelling of the upper lid of right eye. There is no history of such lesion at the same site till the present presentation. Fig- 1

4. EXAMINATION On examination, A well-defined, soft lesion in the medial side of right upper eyelid could be palpated, just below the superior orbital rim, without associated inflammatory signs. It measured 0.5x0.5cm and was round to oval in shape. (see figure 1). Lid position and extraocular movements were normal, with examination of anterior and posterior segment of both eyes revealing no abnormality. Both eyes had visual acuity 6/6 with intraocular pressure 17.3mm of Hg.

5. TREATMENT Considering the fact that its superficial and accessible location of the lesion, direct surgical exicision without any local investigation was planned. Patient underwent excisional biopsy of the lesion under general anesthesia (Fig- 2 to 5) and the mass was sent for histopathology which conformed the diagnosis of capillary haemangioma (Fig- 6). Patients had uneventful post-operative recovery. There was no recurrence after 6 months.

6. Fig- 2 Fig- 3 Fig- 4 Fig- 5

7. DISCUSSION: Capillary hemangiomas are the most common eyelid and orbital tumors of childhood. This tumor has been referred by many names (infantile hemangioma , juvenile hemangioma , hemangioblastoma , benign hemangioendothelioma , hypertrophic hemangioma ), but is most commonly called ‘capillary hemangioma .’ This term is most common as it accurately describes the capillary unit structure of endothelial cells surrounded by pericytes. 4

8. These tumors can present as small isolated lesions, or large masses that can cause visual impairment, systemic effects, or exist as part of a syndrome. Fig- 6

9. Many capillary hemangiomas can be diagnosed on examination, but occasionally identification may require the use of ultrasonography , computed tomography or magnetic resonance imaging for accurate diagnosis. Understanding of this tumor, its natural history, and the indications for treatment are necessary for management of the tumor and to help the patient's family understand the disease process. 5 This case is unique in being presented for the first time at nine years of age and without any recurrence for 6 months after surgical exicision .

10. CONCLUSION Superficial capillary haemangioma of the lid with accurate surgical exicision can prevent recurrence.

11. REFERENCES: 1. Stigmar G, Crawford JS, Ward CM, Thomson HG. Ophthalmic sequelae of infantile hemangiomas of the eyelids and orbit. Am J Ophthalmol 1978;93:496-506 2. Aguilar G, Egbert P. Eyelid tumors. Curr Opin Ophthalmol 1992;3:333-40.. 3. Schwartz SR, Blei F, Ceisler E, et al. Risk factors for amblyopia in children with capillary hemangiomas of the eyelids and orbit. J AAPOS. 2006;10:262–268. 4. Haik BG, Jakobiec FA, Ellsworth RM, Jones IS. Capillary hemangioma of the lids and orbit: an analysis of the clinical features and therapeutic results in 101 cases. Ophthalmol 1979;86:760-89. 5. Wasserman BN, Medow NB, Homa-Palladino M, Hoehn ME. Treatment of periocular capillary hemangiomas . J AAPOS. 2004;8:175–181