Abstract:
Introduction: Infantile hemangiomas (IHs) are common benign vascular tumors of infancy. Periorbital and retrobulbar lesions are uncommon but clinically important because of their potential to compromise vision. Prompt diagnosis and treatment are essential to minimize complications.
Case Presentations: We describe two female infants with rapidly progressive IHs involving the left orbital region.
Case 1: A three-month-old infant presented with progressive swelling of the medial left eyelid and bluish discoloration of the overlying skin. Initial treatment for suspected dacryocystitis produced no improvement. Magnetic resonance imaging (MRI) subsequently identified a left orbital hemangioma. Oral propranolol (Hemangiol) was started at 3 mg/kg/day and was well tolerated, with marked clinical regression. Although a 12-month course was planned, the parents discontinued treatment after approximately 10 months following an episode of collapse that was assessed as unrelated to therapy. MRI performed one month after treatment discontinuation showed no residual orbital lesion.
Case 2: A female infant presented with rapidly progressive left-sided exophthalmos. Thyroid disease was investigated because of a paternal history of hyperthyroidism. MRI demonstrated an infiltrative retrobulbar lesion involving the orbital fat, extraocular muscles, and the region of the optic nerve, with imaging features strongly suggestive of IH. Diagnostic uncertainty and consideration of surgery or biopsy delayed the initiation of treatment until approximately six months of age. Following multidisciplinary evaluation, oral propranolol (Hemangiol) was initiated at 3 mg/kg/day. Marked clinical improvement was apparent within two months. Treatment was continued for a total of approximately 12 months. Follow-up MRI showed complete radiological regression without residual orbital abnormalities.
Results: Both infants demonstrated an excellent clinical response to systemic propranolol, with no residual lesions identified on follow-up MRI. Treatment tolerability was very good, and neither patient underwent biopsy or surgery.
Conclusions: These cases emphasize the importance of recognizing orbital IH in infants presenting with atypical eyelid swelling or unilateral exophthalmos. MRI and multidisciplinary evaluation can guide diagnosis and treatment when invasive procedures carry substantial risk. Oral propranolol may provide effective, well-tolerated, non-surgical management even for complex retrobulbar lesions near the optic nerve. Treatment duration and follow-up should be individualized.
Biography:
Dr. Tatyana Itova, MD, PhD, is a pediatrician and neonatologist with extensive clinical experience in neonatal intensive care and the follow-up of preterm and high-risk infants. Her professional interests include neonatal intensive care, long-term neurodevelopmental follow-up, early intervention, and child health. She actively participates in national programs promoting early childhood development and developmental support. Dr. Itova is the Head of the Department of Neonatology at Medika University Hospital in Ruse, Bulgaria, and a lecturer at the University of Ruse “Angel Kanchev.”
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