Beta Blockers in the Treatment of Periocular Infantile Hemangiomas: A Review

Abstract

Infantile hemangiomas (IH) are the most common benign tumor of infancy, and in the periocular region can be associated with permanent visual impairment from amblyopia. Previous treatment options included systemic and local corticosteroids, surgical excision, laser therapy, and in rare cases immunomodulatory therapy, many of which had variable outcomes with undesirable side effect profiles. Since their initial use for IH in 2008, beta blockers have become the mainstay of therapy for periocular IH due to their excellent clinical efficacy and tolerability. While the exact mechanism of action of beta blockers in IH has not been fully elucidated, both oral and topical therapy have demonstrated low rates of adverse events and improved outcomes in the management of periocular IH. This review summarizes the most recent studies on the clinical outcomes, management, and guidelines for the treatment of periocular IH with topical and oral beta blockers.

Medical management of vascular anomalies of the head and neck

“… 4 Oral propranolol is dramatically effective in treating IHs: when treatment is given early, at the onset of the proliferative phase, the tumor growth is stopped. Propranolol works rapidly and is particularly effective for treatment of subglottic IHs 5 , 6 and periorbital IHs 7 that are responsible for visual axis obstruction. The indication and initiation of propranolol must be performed in an experienced center with monitoring of blood pressure and heart rate 1 h and then 2 h after first the dose, and then treatment is given on an outpatient basis.…”