Abstract
Capillary haemangioma or infantile haemangioma (IH) is the most common congenital vascular tumour in the periocular region. Several treatment modalities have been documented, with variable degree of success. Propranolol has recently been reported to be an effective and safe alternative. The aim of this systematic review is to examine the evidence base for the use of propranolol administered orally in the management of periocular capillary haemangioma, and use this information to guide future research. A systematic review of literature was carried out by two independent reviewers using the search strategies highlighted below. A total of 100 cases of oral propranolol use in periorbital or orbital capillary haemangiomas have been documented in the literature. Of the 85 cases that had details of previous treatment, it was used as first-line treatment in 50 (58.8%). The commonest dose used was 2 mg/kg/day. Adverse events were documented in one-third of cases; in most cases these were minor. Improvement or complete resolution of the lesions occurred in 96% of cases. Recurrence was noted in one-fifth of cases. Propranolol has shown a lot of promise in the therapy of IH and further research in the form of properly designed randomized trials is certainly warranted. Treatment guidelines based on literature available to date is included in this review.
Similar content being viewed by others
Log in or create a free account to read this content
Gain free access to this article, as well as selected content from this journal and more on nature.com
or
References
Gard R, Gupta N, Sharma A, Jain R, Beri S, D’Souza P . Acquired capillary haemangioma of the eyelid in a child. J Paediatr Ophthalmol Strabismus 2009; 46: 118–119.
Drolet BA, Esterly NB, Frieden IJ . Haemangiomas in children. N Engl J Med 1999; 341: 173–181.
Finn MC, Glowacki J, Mulliken JB . Congenital vascular lesions: clinical application of a new classification. J Pediatr Surg 1983; 18: 894–899.
Cruz OA, Siegfried EC . Propranolol treatment for periocular capillary haemangiomas. J AAPOS 2010; 3: 251–256.
Fay A, Nguyen J, Jakobiec FA, Meyer-Junghaenel L, Waner M . Propranolol for isolated orbital infantile haemangioma. Arch Ophthalmol 2010; 128: 256–258.
Maguiness SM, Frieden IJ . Current management of infantile haemangiomas. Semin Cutan Med Surg 2010; 29: 106–114.
Tambe K, Munshi V, Dewsbery C, Ainsworth JR, Willshaw H, Parulekar MV . Relationship of infantile periocular haemangioma depth to growth and regression pattern. J AAPOS 2009; 13: 567–570.
Al Dhaybi R, Milet A, McCuaig C, Ospina L, Powell J . Treatment of periocular infantile haemangioma with propranolol: review of 17 cases. Pediatr Dermatol 2009; 26: 665–666.
Ceisler E, Bleij F . Ophthalmic issues in haemangiomas of infancy. Lymphat Res Biol 2003; 4: 321–330.
Apfellberg DB, Maser MR, White DN, Lash H, Lane B, Marks MP . Benefits of contact and non-contact YAG laser for periorbital haemangiomas. Ann Plast Surg 1990; 24: 397–408.
Tronina SA, Bobrova NF, Khrinenko VP . Combined surgical method of orbital and periorbital haemangioma treatment in infants. Orbit 2008; 27: 249–257.
Léauté-Labrèze C, Dumas de la Roque E, Hubiche T, Boralevi F . Propranolol for severe haemangiomas of infancy. N Engl J Med 2008; 358: 2649–2651.
Haider KM, Plager DA, Neely DE, Eikenberry J, Haggstrom A . Outpatient treatment of periocular infantile haemangiomas with oral propranolol. J AAPOS 2010; 14: 251–256.
Sans V, Dumas de la Roque E, Berge J, Grenier N, Boralevi F, Mazereeuw-Hautier J et al. Propranolol for severe infantile haemangiomas: follow-up report. Pediatrics 2009; 124: 423–431.
Milet A, Al Dhaybi R, Superstein R, Powell J, Hamel P, Chevrette L et al. Propranolol for the treatment of periocular capillary haemangiomas. J AAPOS 2010; 14: e5.
Lawley LP, Siegfried E, Todd JL . Propranolol treatment for haemangioma of infancy: risks and recommendations. Pediatr Dermatol 2009; 26: 610–614.
Holmes WJM, Mishra A, Gorst C, Liew SH . Propranolol as first-line treatment for rapidly proliferating infantile haemangiomas. J Plast Reconst Aesth Surg 2010; 125: 420–427.
Bang G . Propranolol in treatment of capillary haemangiomas. Pediatric Ophthalmology Grand Rounds, University of Illinois Eye and Ear Infirmary, http://www.uic.edu/com/eye (accessed on 31 October 2010).
Tan ST, Itinteang T, Leadbitter P . Low-dose propranolol for infantile haemangioma. J Plast Reconst Aesth Surgery 2011; 64: 292–299.
Taban M, Goldberg RA . Propranolol for orbital haemangioma. Ophthalmology 2010; 117(1): 195–195.e4.
Holland KE, Frieden IJ, Frommelt PC, Mancini AJ, Wyatt D, Drolet BA . Hypoglycemia in children taking propranolol for the treatment of infantile haemangioma. Arch Dermatol 2010; 146: 775–778.
Li YC, McCahon E, Rowe NA, Martin PA, Wilcsek GA, Martin FJ . Successful treatment of infantile haemangiomas of the orbit with propranolol. Clin Experiment Ophthalmol 2010; 38 (6): 554–559.
Arneja JS, Pappas PN, Shwayder TA, Cullen ML, Becker CJ, Hamzavi FH et al. Management of complicated facial haemangiomas with beta-blocker (propranolol) therapy. Plast Reconstr Surg 2010; 126 (3): 889–895.
Manunza F, Syed S, Laguda B, Linward J, Kennedy H, Gholam K et al. Propranolol for complicated infantile haemangiomas: a case series of 30 infants. Br J Dermat 2010; 162: 452–468.
Cheng JF, Gole GA, Sullivan TJ . Propranolol in the management of periorbital infantile haemangioma. Clin Exp Ophthalmol 2010; 38: 547–553.
Chik KK, Luk CK, Chan HB, Tan HY . Use of propranolol in infantile haemangioma among Chinese children. Hong Kong Med J 2010; 16: 341–346.
Fabian ID, Ben-Zion I, Samuel C, Spierer A . Reduction in astigmatism using propranolol as first-line therapy for periocular capillary haemangioma. Am J Ophthalmol 2011; 151: 53–58.
Mishra A, Holmes WJM, Gorst C, Liew SH . Role of propranolol in the management of periocular haemangiomas. Plast Refract Surg 2010; 2: 671.
Ernemann U, Kramer U, Miller S, Bisdas S, Rebmann H, Breuninger H et al. Current concepts in the classification, diagnosis and treatment of vascular anomalies. Eur J Radiol 2010; 1: 2–11.
MicromedexR Healthcare Series. (Internet Database), Greewood Village, CO: Thomson Healthcare. Updated periodically. Available at: http://www.thomsonhc.com/hcs/librarian/ND_T/HCS/ND_PR/Main/CS/FD86B3/DUPLICATIONSHIELDSYNC/A57282/ND_PG/PRIH/ND_B/HCS/SBK/3/ND_P/Main/PFPUI/6DTTNe2E3UQuC/PFActionId/hcs.common.RetrieveDocumentCommon/DocId/2119/ContentSetId/31/sectionId/adverseReactionsSection/SearchTerm/propranolol%20/SearchOption/BeginWithip8 (accessed 31 October 2010).
Haik BG, Karcioglu ZA, Gordon RA, Pechous BP . Capillary haemangioma (infantile periocular haemangioma). Surv Ophthalmol 1994; 38: 399–426.
Bigorre M, Van Kien AK, Valette H . Beta-blocking agent for treatment of infantile haemangioma. Plast Reconstr Surg 2009; 6: 195e–196e.
Buckmiller LM . Propranolol treatment for infantile haemangiomas. Curr Opin Otolaryngol Head Neck Surg 2009; 6: 458–459.
Laquer V, Hoang V, Nguyen A, Kelly KM . Angiogenesis in cutaneous disease: Part II. J Am Acad Dermatol 2009; 61: 945–958.
Tucci FM, De Vincentiis GC, Sitzia E, Giusio L, Trozzi M, Bottero S . Head and neck vascular anomalies in children. Int J Paed Otorhinolaryngol 2009; 73S: S71–S76.
Boye E, Jinnin M, Olsen BR . Infantile haemangioma: challenges, new insights, and therapeutic promise. J Craniofac Surg 2009; 20 (Suppl 1): 678–684.
Love JN, Sikka N . Are 1-2 tablets dangerous? Beta-blocker exposure in toddlers. J Emerg Med 2004; 26: 309e14.
Léauté-Labrèze C, de la Roque ED, Taïeb A . More on propranolol for haemangiomas of infancy. N Engl J Med 2008; 26: 2846–2847.
Buckmiller LM, Richter GT, Suen JY . Diagnosis and management of haemangiomas and vascular malformations of the head and neck. Oral Dis 2010; 5: 405–418.
Halamek LP, Stevenson DK . Neonatal hypoglycaemia, part II: pathophysiology and therapy. Clin Pediatr (Phila) 1998; 1: 11–16.
Pope E, Chakkittakandiyil A . Topical timolol gel for infantile haemangiomas: a pilot study. Arch Dermatol. 2010; 5: 564–565.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Competing interests
The authors declare no conflict of interest.
Author contributions
KSC and ARR contributed to the design and conduct. KSC wrote the article and ARR revised the review.
Rights and permissions
About this article
Cite this article
Spiteri Cornish, K., Reddy, A. The use of propranolol in the management of periocular capillary haemangioma—a systematic review. Eye 25, 1277–1283 (2011). https://doi.org/10.1038/eye.2011.164
Received:
Revised:
Accepted:
Published:
Issue date:
DOI: https://doi.org/10.1038/eye.2011.164
Keywords
This article is cited by
-
Therapie und Versorgung von orbitalen Tumoren
Der Ophthalmologe (2021)
-
Beta-blockers versus corticosteroids in the treatment of infantile hemangioma: an evidence-based systematic review
World Journal of Pediatrics (2013)
-
Reply to Spiteri Cornish and Reddy
Eye (2012)
-
Reply to Spiteri Cornish and Reddy
Eye (2012)


