THE USE OF TOPICAL TIMOLOL MALEATE TO TREAT PERIOCULAR INFANTILE HEMANGIOMA

Title THE USE OF TOPICAL TIMOLOL MALEATE TO TREAT PERIOCULAR INFANTILE HEMANGIOMA
Author, Co-Author Lily Zhu-Tam, Dennis Chui
Topic
Year
2012
Day
Program Number
125121
Room
Exhibit Hall E
Affiliation
Albert Einstein College of Medicine
Abstract BACKGROUND: Hemangiomas are commonly seen in infants. They can occur anywhere, resulting in functional and aesthetic consequences. Periocular hemangioma can have potential vision threatening sequelae. Traditional treatments have major side effects. We present a case of a periocular infantile hemangioma treated with topical timolol maleate; thus supporting evidence for a new potential standard of care

CASE REPORT(S): 3 mth old, Hispanic, female was referred for consultation of a lid lesion. Her parents reported rapid growth since its first appearance at 1 mth old. Medical history is remarkable for a congenital heart murmur. Family history of hemangioma in her half sister resolved at age 6. VA was fix and follow OU with resistance to occlusion of OD. No strabismus was apparent on Hirschberg testing. Anterior segment exam revealed a large red, round 10mm wide firm lesion on the left upper lid. Palpebral aperture size was 8mm OD and 4mm OS. Cycloplegic refraction revealed +2.50D OD and +4.50-2.00x180 OS. DFE was unremarkable. Findings were consistent with a capillary hemangioma and anisometropic meridional amblyopia due to mechanical ptosis OS. Amblyopia therapy was implemented. 30 min of patching with near eye hand coordination activities daily in supine position. After consultation with pediatric ophthalmology and clearance from pediatric cardiology, we started the patient on 2 gtts of topical timolol maleate 0.5% to left upper eyelid BID with punctual occlusion. Subsequent follow up visits showed markedly less redness and vessel engorgement with an increased palpable softening of the lesion. Also, the size decreased to 8mm wide, aperture size increased to 7mm OS and astigmatism decreased to +1.50-1.00x180 OS. Patient is still undergoing monthly follow up
CONCLUSIONS: Based on our findings, topical timolol has shown to be a safe and effective alternative treatment for infantile hemangioma. With a greater safety profile and success rate, we recommend timolol maleate to be used by eye care providers as a first line treatment to prevent visual threatening sequelae
Affiliation of Co-Authors Bronx-Lebanon Hospital Center
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