eye hemangioma
 
What are eye hemangiomas?
What causes cavernous hemangiomas of the eyes, as the most common congenital non-neoplastic benign tumor?
What are the symptoms?
What is the diagnosis and the best way to treat capillary hemangioma of the eye?
If you want to know about eye hemangiomas, read on.
 

 


Introduction
Epidemiology
Risk factors and predisposing factors for hemangiomas
What are the symptoms of eye hemangiomas?
What are the types of eye hemangiomas?
signs
Diagnosis
Treatment of Cavernous hemangiomas

 


 
Introduction
A hemangioma is actually a noncancerous mass.
This mass is made up of a set of blood vessels and it is said that hemangiomas can occur in different parts of the body, including the skin, subcutaneous tissue, skeletal muscle, as well as internal organs, as well as the eyelid and eyeball, But most of the time the location of the hemangioma is on the surface of the skin or under the skin.
The most common areas of hemangioma in the human body are the head and neck.
Depending on the type of arteries involved in building the hemangioma, the color and shape of the hemangioma will vary, as will the size of the hemangioma.
In the following, we want to talk more about this non-cancerous eye tumor.
Doctors say hemangioma tumors are very rare to become cancerous, so most will not need medical treatment, but in types of hemangiomas that cause appearance problems, for example, in areas that prevent the baby from feeding or prevent the eyelids and eyesight from moving properly and increase the risk of amblyopia and increased intraocular pressure should, surgery must be performed.
In short, hemangiomas do not require surgery.
Unless it is in the muscles or bones, or if tumors are on the surface of the skin that have caused the baby to have trouble in feeding, breathing, or vision, or on the eyelids, around the eyes, around the nostrils, and around the lips and mouth.
The important thing is that if there is an eye hemangioma, the child needs a doctor on a regular basis.

 

Epidemiology
Capillary hemangiomas, commonly referred to as birth mark, are the most common type of benign pre-orbital tumors in childhood.
It has an 18 percent prevalence in all births worldwide and is also three times more common in female infants and girls than in male infants.
Another point is that the occurrence of orbital and eyelid hemangiomas is one in ten cases of systemic hemangiomas and occurs in 10% of all children who are in the first year of life.

 
Risk factors and predisposing factors for hemangiomas
Risk factors for Eye hemangiomas include low birth weight, and premature birth.
These factors have the potential to increase the risk of hemangiomas in infants.
Another reason that is less involved than the above two causes is that women are multiparous, meaning that in multiple deliveries, children born in the last delivery will have a higher risk of developing hemangiomas.
 

What are the symptoms of eye hemangiomas?
The symptoms of Hemangiomas that develop on the eyelid or on the surface of the eye (conjunctiva) or around the eye are different from those on the eye (retina).
Clinical picture of eye hemangiomas of the eyelid and around the eye:
The baby is born, there is an unpleasant lesion on the baby's eyelids and it can be a concern for parents, but it is interesting to say that this lump is harmless and completely benign and will not be dangerous for the baby. It is the most common congenital benign tumor that presents as a vascular mass.
This mass can be superficial and can be seen immediately after the baby is born. It can appear a few weeks to a few months after birth. These tumors do not need treatment. Most cases will resolve spontaneously by age 5 and other hemangiomas by age 10.
 

What are the types of eye hemangiomas?
There are different types of eye hemangiomas, each with its own set of symptoms.
Capillary hemangiomas 
These lumps are sometimes called strawberry nevi and are benign tumors and can be caused by overgrowth of blood vessels. They can also occur on the eyelids, on the surface of the eye (conjunctiva), and also in the socket called the eye orbit. 
60% of capillary hemangioma tumors are found in the upper orbit, 16% in the lower orbit, and 2% in both upper and lower orbits.
These tumors can be small, but large hemangiomas around the eyelids and eyes can cause vision problems.
It is the most common non-neuronal congenital tumor in infants. It is one of the most common tumors of the eyelid and orbit of the eye in childhood. One in every 10 newborns can be affected by hemangiomas of varying severity.
Cavernous hemangiomas 
It is the most common vascular lesion or tumor in the orbital area of ​​the eye and is more common in adults. It grows slowly is benign, and is sometimes asymptomatic and painless, with protrusion and forward displacement of the eye, they are usually seen on one side and are rarely on both sides.
Adult Cavernous hemangiomas are actually surrounded by a distinct fibrous capsule and a definite margin And is a non-permeable vascular neoplasm.
 

signs
We consider the symptoms according to the type of hemangioma:
Cavernous hemangiomas:
Signs and symptoms include, painless protrusion of the eye that gradually progresses, Decreased visual acuity.
Visual field disorder, which can be caused by a pressure effect on the optic nerve. The muscles outside and around the eye can also be involved.
Incidence of diplopia due to external eye muscle disorder, Asymmetry of the axis between the two eyes, Optic muscle disorder and Optic nerve involvement.
Keratopathies, Inflammation of the cornea or keratitis, and perforation of the cornea, Disorder of the pupil of the eye and involvement of nerve structures.
Symptoms of capillary hemangiomas:
Ten to twenty percent of infants have multiple lesions in other areas.
It is three times more common in women than men.
Capillary hemangioma tumors:
It is more common in premature and low birth weight infants and may not be present at birth, but will certainly appear during the first 6 months of life.
Size will also decrease between 12 months and 15 months. Some of these hemangiomas that occur have these characteristics:
Small spots, such as red spots, as well as telangiectasia vessels on the surface layers of the skin.
Most capillary hemangiomas will be completely gone by the age of five or six.
There are many cases of hemangiomas in the upper eyelid. Amblyopia may also occur when the lesion causes the eyelid to droop to such an extent that it blocks the main vision of the eye. Blurred vision in the affected eye can be controlled to some extent with glasses and using drops. 
The most common complication that occurs in 60% of children is blurred vision and vision loss.
If capillary hemangiomas are present in the eye's orbit, they can lead to strabismus. They may also put pressure on the optic nerve. They can also cause optic nerve atrophy and strabismus is also possible due to the Interestingly, capillary hemangiomas enlarge when a child cries, because crying stimulates the Valsalva maneuver. By this definition, the pressure inside the chest when crying increases, causing oxygen-free blood to enter the capillary spaces of the hemangioma, resulting in a larger mass. This symptom is more common, but will not be a diagnostic feature for capillary hemangioma tumors.
 

Diagnosis
An experienced ophthalmologist with a complete eye examination can list appropriate differential diagnoses and can make a clinical diagnosis of hemangioma.
Obtaining a history of clinical imaging, including CT scans and checking for increased intraocular pressure, possible pupil problems, inflammation and swelling of the optic nerve, and other problems should be checked.
Among the paraclinical modalities of diagnostic assistance, the following can be mentioned: CT scan imaging and MRI can help diagnose cavernous hemangiomas, CT scan shows hemangioma as a limited, uniform and clear mass that is a bit thicker than the muscle is and is located inside the eye muscles, and old fat deposits may accumulate inside it.
Radiology will take time for the diagnosis to be uncertain and conditional. Completion of paraclinical procedures can be noted using ultrasound. Around the capillary hemangioma, there will be compact lesions and long intra-tumor tabs on the artery.
CT scan identifies a mass, This imaging method can hardly distinguish these lesions from other vascular lesions, so with CT scan, the patient's age and clinical manifestation of the patient must be considered.
Treatment should be done in different ways depending on the type and severity and what vision problems it has caused.
 

Treatment of laryngeal hemangioma
Surgery:
Tumor size and location are very important in deciding whether to have surgery if the hemangioma is inside the conjunctiva.
It can be either inside or between the skulls. The surgical and treatment methods can be different. The treatment of capillary hemangioma tumors can be done in different ways, depending on the size and problems, and the symptoms.
There are two types of drugs in the treatment of capillary hemangiomas. Propranolol is an effective drug that is used to treat capillary hemangiomas and is taken orally and when the mass is very small and thin, it can be used topically because propranolol is can on affect heart rate and blood pressure, so care must be taken when prescribing and careful care must be taken during treatment.
Doctors may hospitalize the patient for a short time.
Steroid drugs
These steroids can stop the progression and spread of hemangiomas and shrink the tumor itself. Depending on the size and location of the mass, it may be given orally or by direct injection into a vascular mass and they also can be used topically. Delayed physical growth and premature cataract, increased intraocular pressure and Obstruction of the central artery of the retina are among the side effects of this drug.
Laser treatments
Sometimes superficial capillary hemangiomas are treated with laser to prevent them from growing and reduce their size and lighten their color.
Last treatment option, surgery
Surgery is used to remove hemangiomas around the eyes and small tumors under the skin. If the tumor damages the central blood flow to the retina, the person may lose their sight, which is considered a surgical complication. Because the tumor is confined to a specific capsule, there is minimal bleeding.
This surgery carries the risk of damage to the optic nerve of the muscles outside the eye and the structures around the eye.V

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