title: Efficacy of systemic propranolol for severe infantile haemangioma of the orbit and eyelid: a case study of eight patients.
abstract: OBJECTIVE
  To assess the efficacy of systemic propranolol for severe capillary haemangiomas involving eyelid and orbit.
  
  
  METHODS
  This was a longitudinal retrospective study that began in November 2007, involving eight children with disfiguring orbit and eyelid capillary haemangioma who received oral propranolol therapy. Three patients with life-threatening haemangiomas spreading to the orbit were first treated with systemic corticosteroids and beta-adrenergenic blocking agents. The remaining five patients with functional visual impairment received propranolol only. All children were given propranolol at a dose of 2 mg/kg body weight per day. The treatment was initiated between 2 and 36 months of age, with a follow-up period ranging from 6 to 30 months. Beta-blocking agents were used for 3-10 months.
  
  
  RESULTS
  We observed a successful 100% regression: that is, clinical regression by flattening 24 h after the start of treatment, regression on colour Doppler ultrasound imaging with an increase in resistance index of blood vessels, or regression seen on MRI. No re-growth was observed after the trial ended.
  
  
  CONCLUSIONS
  Despite their self-limiting course, infantile orbital and eyelid haemangiomas can cause visual impairment or disfigurement. Corticosteroids are used as first-line therapeutic agents for problematic infantile haemangiomas. Other options include interferon-α and vincristine, which present problematic side effects. In our series, propranolol was shown to inhibit haemangioma tumour growth with a better benefit/risk ratio. In the absence of any randomised study comparing the effects of systemic corticosteroids and propranolol, we propose that beta-blockers could be used as first-line therapy for severe periocular haemangiomas.
authors.affiliation: Ophthalmology Department, Centre Hopsitalo-Universitaire Pellegrin, Place Amélie Raba Léon, Bordeaux, France. francois.thoumazet@chu.bordeaux.fr
authors.forename: F
authors.initials: F
authors.lastname: Thoumazet
authors.forename: C
authors.initials: C
authors.lastname: Léauté-Labrèze
authors.forename: J
authors.initials: J
authors.lastname: Colin
authors.forename: B
authors.initials: B
authors.lastname: Mortemousque
mesh_terms: D000284:Administration, Oral; D000319:Adrenergic beta-Antagonists / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D002675:Child, Preschool; D005142:Eyelid Neoplasms / Q000188:drug therapy* / Q000473:pathology; D005500:Follow-Up Studies; D018324:Hemangioma, Capillary / Q000188:drug therapy* / Q000473:pathology; D006801:Humans; D007223:Infant; D008279:Magnetic Resonance Imaging; D009918:Orbital Neoplasms / Q000188:drug therapy* / Q000473:pathology; D011433:Propranolol / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D000319:Adrenergic beta-Antagonists; D011433:Propranolol