Topical Treatment for Orbital Capillary Hemangioma in an Adult Using a β-Blocker Solution
A 43-year-old female was admitted to hospital with a complaint of bleeding from the right medial ocular angle. She had had a long history of capillary hemangiomas, as described below.\nShe had developed capillary hemangiomas of the right upper eyelid at the age of 4 and of the right buccal region at the age of 9. Both of those lesions were surgically excised at the time of development. She had also developed a right orbital tumor at the age of 13, which was monitored without any treatment. She presented at the age of 34 with a complaint of right proptosis with ocular pain due to the right orbital tumor, which was confirmed to be an orbital capillary hemangioma after being pathologically diagnosed from an endoscopic biopsy at that time. In the biopsy sample, a lot of dilated capillaries were observed in the mucosa (fig. , arrows), indicating that the lesion was a capillary hemangioma/malformation, but not infantile hemangioma. Radiation therapy and surgical excision were considered but rejected due to a risk of visual loss since the lesion was too close to the optic nerve. Fortunately, the right proptosis with ocular pain had almost disappeared 2 months later with no treatment other than the biopsy. She was then observed without any treatment for years.\nHer best-corrected visual acuity was 1.2 OD and 1.5 OS, and the intraocular pressure was 12 mm Hg in both eyes. Slit-lamp examination revealed no abnormalities except the superficial lesions of the capillary hemangioma of her right eye. No abnormalities were found in the retinas of either eye.\nThe hemangioma presented both superficial and deep orbital components. The superficial lesion was seen at the right medial ocular angle, that is, on the upper/lower eyelids, conjunctiva and expanding into the subconjunctival space. It appeared as superficial tortuous blood vessels, and the conjunctiva appeared violet/blue in color (fig. ). The deeper lesion lay posterior to the orbital septum and was detected using MRI with low signal intensity on T1-weighted images versus high signal intensity on T2-weighted images with internal signal void (fig. , arrows) and gadolinium enhancement.\nThe patient was instructed to apply an ophthalmic solution of timolol maleate 0.5% twice daily. The superficial lesion gradually regressed, as shown in fig. , and had almost disappeared after 1 year of treatment (fig. ). The deeper lesion had also reduced in size, with maximal MRI axial dimensions of 16 × 11 mm (fig. ), decreasing to 12 × 8 mm (fig. , arrow) after 1 year of treatment. No apparent recurrence of bleeding in her eye was observed. No local or systemic adverse effects were noted.