Introduction
A capillary hemangioma refers to a non-cancerous (benign) tumor where small blood capillaries or vessels grow abnormally and become numerous. It will most often appear on the brow or eyelid, especially the upper eyelid. Most hemangiomas develop within six months of an infant’s life, although some may be present at birth. Those present at birth are already fully grown and may disappear completely within one year of an infant’s life or may remain.
These blood vessels often grow fast within the first year before they start decreasing in size when the baby is between one year and one and half years. By age 6, most of these tumors have disappeared, and those that persist often go away at puberty. They are said to affect more girls than boys and are commonly found in premature infants.
Capillary hemangiomas are located anywhere on the body. When they affect the eye, they may appear on the conjunctiva (surface of the eye), the eye's socket, or eyelids. Those on the eyelids can affect vision in two ways. One is when a child’s vision is affected by ptosis, a droopy eyelid. If the eyelid droops excessively, it can block vision and cause occlusion amblyopia. Second, astigmatism (vision distortion and loss of focus) results from the growing lesion pressing on the conjunctiva. Refractive amblyopia then develops and impacts vision. A capillary hemangioma on the eye socket or orbit can cause strabismus when it affects eye movement. Optic nerve atrophy can also result when the hemangioma exerts pressure on the optic nerve, impacting vision.
Causes & Risk Factors
A capillary hemangioma in children results from abnormalities in the vascular system's development during fetal growth. Some may develop during pregnancy and disappear.
Signs & Symptoms
Signs and symptoms may include:
- Lesion on the brow or eyelid whose size is small or large
- Slightly raised lesions which at times grow from the stalk
- Soft, painless, and red-blue-like lesions in the mouth as well as skin and lips
- Some lesions may appear raised, bright red, nodular, or lie flat on the skin. Others are purple or dark blue. The lesion may change color or enlarge when the baby is crying. Other lesions become pale with pressure and are spongy when felt with fingers and hands.
Diagnosis
Diagnosis of capillary hemangioma may involve:
Medical history
The doctor will draw medical history from the patient, such as general health and family history. Important information also includes the lesion's history, especially how long it has been there and if there have been significant changes to the lesion over time. Other information includes whether there is pain, other symptoms, and when the symptoms started
Physical examination
The doctor examines the lesion and looks for information such as location, surrounding skin changes, and what the lesion feels like
Imaging tests
Imaging tests such as X-ray and magnetic resonance imaging which can provide clear pictures of the lesion. The doctor can see how the blood vessels have gathered.
Angiography
This test uses a dye that is injected into the vein in the surrounding bloodstream. The pictures taken as the dye travels through the bloodstream will reveal the hemangioma
Biopsy
Because it’s challenging to differentiate a capillary hemangioma from other tumors, it may be necessary to confirm the diagnosis via a biopsy. The microscope is used to examine a sample of the tissue collected from the tumor
Blood tests for genetic analysis
These are necessary if multiple tumors exist or the symptoms concern specific disease patterns
Treatment
In most cases, a capillary hemangioma will shrink and disappear completely without requiring treatment. Treatment is necessary when the hemangioma causes significant problems with sight and other vital functions. Sometimes the lesion can grow too big to affect the emotional needs of the child. Treatment depends on where the hemangioma is located and whether it affects vision. In some cases, observation is the only treatment where the lesion is regularly monitored.
Medical Treatment
Medication such as beta-blockers taken orally are prescribed depending on the size and type of the lesion. For example, beta-blocker eye drops such as Timolol can be applied to the lesion if it is small, thin, and superficial. Oral beta-blockers can slow the growth of the hemangioma. Hospital admission may be necessary to monitor blood pressure and heart rate at the start of treatment by beta-blockers. Steroids (oral, injection, or ointment) can be used to stop the hemangioma from progressing. However, steroids usually have side effects such as delayed physical growth, glaucoma, cataract, and so on.
Eyeglasses to treat amblyopia. Occlusion therapy using atropine drops and patches can also treat amblyopia.
Radiation therapy can be used in treating some capillary hemangiomas.
Surgical Treatment
Surgery involves cutting out the hemangioma if the lesion is well-defined and located under the skin’s surface. It is considered when other methods have failed.
Laser treatment can help with a superficial lesion, which causes it to shrink or prevent it from growing. It also helps to lighten the color of a capillary hemangioma. Multiple laser treatments may be necessary in some cases.
Embolization is a procedure used to close off the blood supply. The surgeon injects small particles into the blood vessels, blocking off the blood vessels. The procedure can be used to decrease the chances of a patient losing a lot of blood. Sclerotherapy uses chemical agents to close off the blood vessels. The procedure helps to shrink the tumor and reduce pain. However, these two procedures do not cause the hemangioma’s complete disappearance since the lesion grows back its blood supply over time.
Home Care
Inflatable leggings or sleeves can be used to apply pressure to the tumor to reduce the swelling. However, this method may not cause the hemangioma to disappear.
Prognosis & Long-Term Outlook
A capillary hemangioma under observation usually takes several years to go away completely. The skin may appear creased and still retain the red color. The skin may also look perfectly normal after the hemangioma has resolved.
Prevention & Follow Up
Children with a capillary hemangioma are monitored in case vision problems develop. It's essential that even those who do not require treatment regularly visit the doctor for any changes in the lesion.
