Oral propranolol for treatment of periocular infantile hemangiomas

Objective: To evaluate the efficacy and adverse effects of oral propranolol for treatment of periocular infantile hemangioma. Methods: Participants were treated with oral propranolol 3 times daily, with outpatient monitoring of adverse effects. The starting dosage was 0.5 mg/kg/d for 1 week, then 1 mg/kg/d for the following week, then 2 mg/kg/d for the remaining duration of treatment. Serial examinations and external photography documented the size of the hemangiomas. Complete ophthalmic examinations included assessing for amblyopia with cycloplegic refraction and visual diagnostic testing. Amblyopia was treated with part-time occlusion therapy. Results: Nineteen periocular hemangiomas from 17 children (71% girls) were studied. The median age at the start of treatment was 4.5 months (interquartile range, 2.2-5.6 months). The median treatment duration was 6.8 months (interquartile range, 4.1-7.2 months). Treatment with oral propranolol reduced the size of all hemangiomas. Median change in the surface area was 61% (interquartile range, 32%-64%) of the original size. Mild rebound growth that did not necessitate retreatment was found in 2 patients (12%). One patient (6%) experienced a benign episode of bradycardia. Seven patients (41%) had amblyopia. Conclusions: Oral propranolol for treatment of infantile hemangiomas was effective in all patients, with 33% reduction in astigmatism and 39% reduction in surface area. Vision equalized in all but 1 child, who receives ongoing amblyopia therapy. Our results suggest that early treatment with propranolol is remarkably effective in treating and preventing loss of visual acuity associated with periocular infantile hemangiomas.