Hemangioma is a non-benign tumor formed from a connected mass of blood vessels. It can occur on any part of the body including the face, neck, chest and back. When it involves the eyes, hemangioma can manifest itself on the eyelids, sockets, or on the surface around the eye.
The growth can be present and fully developed at birth (congenital) or can appear a few months after the infant is born (infantile). Congenital hemangioma may develop rapidly but in most cases, it shrinks within 12 to 24 months. Infantile hemangioma is the most common form. It follows a distinct pattern of growth with the following stages:
- Proliferative stage - There is rapid growth of the tumor in size. This occurs during the first year of birth.
- Resting stage - This proceeds the proliferative stage. At the resting stage, there’s little to no change that occurs in the tumor. This happens between the ages of 1 and 2.
- Involution – At this stage, the growth begins to shrink. In about half of the cases, the tumor goes away by the age of 5. By the age of 10, the growth is usually gone in nearly all cases. Traces of the growth may, however, remain years later.
Although rare, hemangioma may not disappear at all.
Also Known As
- Capillary hemangioma – This is the most common type of hemangioma. It is a closely-packed mass of small capillaries held together by connective tissues. The growth develops in close proximity to the skin. As a result, it is also referred to as superficial hemangioma.
- Cavernous hemangioma – Unlike in capillary hemangioma, cavernous hemangioma is made up of large blood vessels. It also has spaces in between which are filled with blood. When the growth develops in the skin, it is known as deep hemangioma.
- Compound hemangioma – This is a mixture of both capillary and cavernous hemangioma. It involves a mass of blood vessels that form on the surface and beneath the skin.
Causes and Risk Factors
Hemangioma occurs due to an abnormal growth of blood vessels. It is, however not clear what causes the abnormality. Most cases are linked to genetic problems. Risk factors for development of the tumor include:
- Premature birth
- Caucasian descent
- Female gender
Signs & Symptoms
Hemangioma will usually start as a small red bump, a bruise or scratch. With time, the growth changes in size and shape. There may also be more than one tumor. Other signs and symptoms include:
- Strawberry-like mass – For superficial tumors, the growth will be bright red in color. Deep hemangiomas on the other hand are blue or purple in color.
- Pain - Hemangiomas are usually painless but where there’s ulceration or swelling, they can cause a lot of pain.
- Bulging out of the eye – This may occur where there is involvement of the orbit of the eye
Hemangioma can easily be confused with other vascular malformations. The eye care professional may conduct the following tests to confirm presence of the tumor:
- Medical history exam – This includes questions of when and how the growth began. The eye doctor may also ask if there have been any changes in the size.
- Imaging tests – A magnetic resonance imaging test (MRI) is also useful in diagnosing hemangioma.
- Biopsy – This involves taking a sample of tissues from the tumor and examining it under a microscope.
Treatment of hemangioma depends on size, location and severity.
Most cases resolve on their own. However, a few medications can be indicated. They include:
- Anti Inflammatory drugs – Corticosteroids are the most common anti inflammatories given. They can be administered orally, topically or through an injection. They work by causing the blood vessels to shrink. Corticosteroids, however, increase the risk of developing high blood pressure, poor growth and cataracts in individuals.
- Propranolol – It belongs to a group of drugs deferred to as beta-blockers. The medication can be taken orally or can be applied. It has fewer side effects compared to steroids.
- Laser therapy – It helps to stop the growth, diminish the size or lighten the color in superficial growths. It is done in hemangioma that occurs on the skin.
- Surgical incision – This is reserved for well-defined tumors that occur beneath the surface of the skin. It involves removal of the hemangioma. Surgery is deemed necessary where there’s a lot of pain or where there’s destruction of surrounding tissues/organs.
Hemangiomas most commonly resolve without causing any issues. However, in some cases, patients can expect complications such as:
- Ulcerations – The tumor may break down and develop a sore. This causes bleeding, pain, scarring and may even result in an infection.
- Problems with vision – The growth may block vision or put pressure on the eye. Complications involving the eye can include amblyopia, astigmatism and loss of sight.
Hemangioma can not be prevented. It is important to visit an eye care provider for regular check ups to prevent progression.