Treatment of Infantile Capillary Hemangioma of the
Eyelid with Systemic Propranolol
PATRIZIA VASSALLO, RAIMONDO FORTE, ANTONIO DI MEZZA, AND ADRIANO MAGLI
● PURPOSE: To assess the efficacy and safety of systemic
propranolol for infantile capillary hemangiomas of the
eyelid.
● DESIGN: Prospective, interventional cases series.
● METHODS: All patients with eyelid infantile capillary
hemangiomas at risk of developing amblyopia seen be-
tween January 2009 and January 2012 at the University
Federico II, Naples, Italy, were treated with systemic
propranolol (2 mg/kg body weight per day). Maximum
length of treatment was 4 months, and propranolol was
suspended when complete regression of lesions was ob-
tained or in case of collateral effects. Minimum follow-up
was 6 months.
● RESULTS: Of 17 patients with eyelid infantile capillary
hemangiomas, 3 were excluded for asthma and 14 (7
males, 7 females; mean age, 20.85 ⴞ 29.7 months; range,
1 to 72 months) underwent treatment with systemic
propranolol. Capillary hemangiomas involved the upper
eyelid in 10 cases and the lower eyelid in 4 cases.
Propranolol was stopped in 1 case for hypotension and in
1 case for allergy. Treatment was administered over
a mean of 2.5 ⴞ 1.3 months (range, 1 to 4 months); the
mean follow-up was 10.64 ⴞ 8.7 months (range, 6 to 39
months). Ten patients were younger than 1 year and
demonstrated complete regression. Two patients older
than 5 years also benefited from treatment. In 4 cases,
amblyogenic astigmatism was present and decreased from
1.25 ⴞ 0.5 diopters before treatment to 0.25 ⴞ 0.2
diopters after treatment. No regrowth was observed.
● CONCLUSIONS: Four months of treatment with oral
propranolol for eyelid infantile capillary hemangiomas
led to complete regression of the lesion in patients
younger than 1 year. No major collateral effects were
observed. Treatment also may be considered in patients
older than 5 years to reduce astigmatism and for aesthetic
purposes. (Am J Ophthalmol 2013;155:165–170.
© 2013 by Elsevier Inc. All rights reserved.)
Accepted for publication June 14, 2012.
From the Department of Ophthalmology, University Federico II,
Naples, Italy (P.V., R.F., A.M.); and the Department of Pediatrics,
University Federico II, Naples, Italy (A.D.M.).
Dr Magli is currently affiliated with the Pediatric Ophthalmology
Department of The University of Salerno, Italy.
Inquiries to Raimondo Forte, Dipartimento di Scienze Oftalmologiche,
Università Federico II, Via Pansini 5, 80131 Naples, Italy; e-mail:
raiforte@gmail.com
0002-9394/$36.00 © 2013 BY ELSEVIER INC. ALL
http://dx.doi.org/10.1016/j.ajo.2012.06.021
I
NFANTILE CAPILLARY HEMANGIOMAS ARE THE MOST
common tumors of the eyelid in infancy.1,2 They appear
shortly after birth and usually begin to involute spon-
taneously in early childhood. Many involuted lesions do
not need to be treated using corrective surgery, but in some
cases, treatment is necessary because of vision loss second-
ary to amblyopia induced by astigmatism, ptosis, or globe
displacement.3 Therapeutic options include intralesional,
topical, or systemic corticosteroids as a first line of treat-
ment,4,5 and interferon ␣, vincristine, cyclophosphamide,
topical imiquimod, focal laser photocoagulation, and sur-
gical excision as secondary therapeutic options.6,7 In 2008,
the successful effect of oral propranolol therapy on severe
infantile hemangiomas was reported by Léauté-Labrèze and
associates in patients treated for high-output cardiac fail-
ure.8 In this study, we evaluated the efficacy and adverse
effects of oral propranolol treatment in patients with eyelid
infantile capillary hemangiomas.
METHODS
IN THIS PROSPECTIVE INTERVENTIONAL STUDY, WE IN-
cluded all patients with eyelid infantile capillary heman-
giomas at risk of occlusive or refractive amblyopia.
Recruitment was conducted at the Pediatric Ophthalmol-
ogy Department and in the Pediatric Department of the
University Federico II, Naples, Italy, between January
2009 and January 2012. The main inclusion criterion was
the presence of an eyelid hemangioma that could deter-
mine occlusive or refractive amblyopia because of its
position and size. Exclusion criteria for treatment were the
presence of an intraconic lesion, congestive cardiac failure,
asthma, and obstructive pulmonary disease. Informed con-
sent was obtained in accordance with institutional review
board approval. Before initiation of treatment, 2 visits
within 1 month were scheduled to exclude spontaneous
improvement of the lesion. All children included in the
study were given propranolol at a dose of 2 mg/kg body
weight per day. Treatment was suspended when a complete
flattening of the hemangioma was obtained or in case of
adverse effect. Treatment was administered during a max-
imum period of 4 months to obtain an antiamblyopic effect
by minimizing the risk of collateral effects. All patients
underwent a cardiology evaluation (including electrocardiog-
raphy and echocardiography) before treatment. The un-
wanted general effects of ␤-blockers were monitored carefully
RIGHTS RESERVED. 165
monthly by a general pediatrician (A.D.M.) under ambula-
tory conditions (rhythm cardiac monitoring, pulmonary

Follow-up
(mos)

8
39
6
15
9
11
6
6

15
9
6
7

6
6
sounding, blood pressure monitoring, research of acrocyano-
sis, nightmares, drowsiness, irritability, and gastric acid back-
ward flow). In case of blood hypotension or rhythm cardiac

Allergy
Effects
Side

hTA
abnormalities, a heart echography was scheduled.

NA
NA

NA
NA
NA
NA
NA

NA
NA

NA

NA
NA
Minimum length of follow-up was 6 months. All children

Posttreatment
Amblyopia
were examined at baseline, at 1 week after initiation of

No
No
No
No
No
No
No
No

No
No
No
No
No
No
TABLE 1. Capillary Hemangioma of the Eyelid Treated with Systemic Propranolol: Summary of Patient Characteristics and Outcomes
treatment, at 1 month, and then at monthly intervals until
total regression and after therapy ended. Ophthalmologic
examinations included assessment of visual fixation prefer-

Ptosis
ptosis

ptosis

ptosis
Cause of Amblyopia
ence, eyelid function and ptosis, extraocular motility, anterior
segment, dilated funduscopy, and cycloplegic refraction. To

Astigmatism,

Astigmatism,
Astigmatism,

Astigmatism,
obtain the astigmatic difference, the cylinder measurement in

Occlusion
Occlusion
the affected eye was subtracted from the cylinder measure-

Ptosis

Ptosis
ment in the unaffected eye. A difference of 1.50 diopters or

NA

NA

NA
NA

NA

NA
more in astigmatism (in accordance with the preferred

Pretreatment
practice pattern of the American Academy of Ophthal-

Amblyopia

F ⫽ female; hTA ⫽ arterial hypotension; LE ⫽ lower eyelid; M ⫽ male; mos ⫽ months; NA ⫽ not applicable; UE ⫽ upper eyelid.
Yes

Yes
Yes

Yes
Yes

Yes

Yes

Yes
mology9), ptosis, eyelid contour changes at risk of causing

No

No

No
No

No

No
occlusion, strabismus, or globe displacement were consid-
ered to be significant amblyogenic factors. Demographic

Posttreatment
Astigmatism
information, age at first visit to clinic, age at start of

(Diopters)

⫹0.25

⫹0.25
⫹0.5
treatment, duration of treatment, and indication for treat-

0
0
0
0
0

0
0
0
0

0
0
ment were recorded.
Size of the hemangioma was documented by B-scan
Pretreatment
Astigmatism
(Diopters)
echography, by clinical examination, and by photography ⫹1
0
0
0
0
⫹2
⫹1
0
0
0
0
⫹1
0
0
at treatment onset, throughout treatment, and at the
conclusion of treatment. The visual analog scale was used
to compare the response to treatment because it was used
(Snellen)

32/25

32/25

25/25

32/25
Acuity
Visual

NA
NA
NA
NA

NA

NA
NA

NA
NA
NA
in previous studies evaluating the response of infantile
capillary hemangiomas to corticosteroids and propranolol
treatment.10,11 Two expert ophthalmologists (P.V., R.F.),
Worsening
Worsening
Worsening
Worsening

Worsening

Worsening
Worsening

Worsening
Worsening
Worsening
Progression
Lesion

blinded to the patients, independently assessed the efficacy

Stable

Stable

Stable

Stable
of the therapy by analyzing the clinical photographs at
baseline and at 6 months. The clinical score for the overall
Involving elevator muscle

change in the infantile capillary hemangiomas used a

100-mm VAS with a range from ⫺100 to ⫹100. An
Type of Hemangioma

assessment between ⫺100 mm and 0 reflected a deterio-

ration of the infantile capillary hemangiomas, and an
assessment between 0 and ⫹100 mm reflected an improve-
Superficial
Superficial
Superficial
Superficial
Superficial
Superficial

Superficial
Superficial
Superficial
Superficial
Superficial
Superficial
Superficial

ment of the infantile capillary hemangiomas. Doubling in

size was recorded as ⫺100 mm, absence of change was
recorded as 0, and complete resolution was recorded
as ⫹100 mm. The percentage of change from baseline then
Site

UE
UE

UE
UE
UE
UE

UE
UE
UE

UE
LE
LE

LE

LE

was translated by determining the distance on the VAS

Treatment
Duration

from point 0, with each 5 mm equaling a 5% change from

(mos)

4
2
2
1
4
1
4
3
1
4
3
4
1
4

baseline. Side effects of therapy were evaluated at each

follow-up visit. The main outcome measure was posttreat-
Onset, (mos)
Treatment

ment regression of lesions measured by the visual analog

Age at

9
8
7
7
23
2
72
3
4
48
4
4
5
96

scale and echography. Secondary outcome measures were

improvement in astigmatism, amblyopia, and visual acuity
and the safety of therapy.
Sex

M
M

M
M

M
M
F

F
F
F
F

All analyses were performed with the SPSS software

version 18 (SPSS, Inc, Chicago, Illinois, USA). Con-
Patient
No.

1
2
3
4
5
6
7
8
9
10
11
12
13
14

tinuous variables, such as age, duration of ophthalmo-

logic follow-up, and VAS, were described using mean,

166 AMERICAN JOURNAL OF OPHTHALMOLOGY JANUARY 2013

 TABLE 2. Capillary Hemangioma of the Eyelid Treated with Systemic Propranolol: Summary of Lesion Characteristics at Baseline
and at the 6-Month Visit

Patient Size on Baseline Photography Thickness on Baseline Size on Photography at Last Thickness on Echography VAS Results at 6-Month Visit
No. (Height/Width), cm Echography, cm Visit (Height/Width), cm at Last Visit, cm (Evaluator 1/Evaluator 2)

1 2.5/2 2 0.5/0.5 0 100/98

2 2/1 1 0.5/0.3 0 96/100
3 5/3 2 0.5/0.5 0.5 80/82
4 3/4 2 0/0 0 96/98
5 2/1 1 0.5 60/64
6 3/2 1.5 0/0 0 100/98
7 1.5/1 1 0.7/0.5 0.5 80/75
8 3/2 1.5 0/0 0 100/98
9 2.5/2 1 0/0 0 100/100
10 3/5 1 0.5/0.5 0.5 80/82
11 2/1.5 0.9 0/0 0 100/100
12 2/1 1 0.3/0.3 0 98/94
13 0.5/0.8 0.5 0/0 0 100/100
14 2/1 1 0.5/0.3 0.5 85/82

VAS ⫽ visual analog scale.

FIGURE 1. Photographs of an infant 4 months of age with an upper eyelid infantile capillary hemangioma causing ptosis and
astigmatism obtained after 4 months of propranolol treatment (Patient 12). (Left) Before propranolol treatment astigmatism is
present. (Middle left) At the 1-week visit, softening and lighter coloration of the lesion is observed. (Middle right) At the 6-month
visit and (Right) at the 10-month visit, resolution of the astigmatism with decrease in thickness and redness of the infantile capillary
hemangioma are present.

standard deviation, and median values in the studied
patients. The agreement between the 2 evaluators of
VAS was measured using the intraclass correlation
coefficient and respective P values (P ⬍ .05 was con-
sidered significant).17–20
RESULTS
THREE PATIENTS WITH INTRACONIC HEMANGIOMA AND
17 patients with eyelid hemangioma were seen in the
recruitment period. Of 17 patients with eyelid heman-
gioma, 3 were excluded because of a history of asthma
and 14 (7 males, 7 females) underwent treatment with
systemic propranolol. Treatment was initiated at an age
of 20.85 ⫾ 29.7 months (range, 2 to 96 months; mean,
5.3 ⫾ 2.3 months if 1 23-month-old child, 1 72-month-
old child, 1 96-month-old child, and 1 48-month-old
child are excluded). A summary of patient characteris-
tics and outcomes is reported in Table 1. Lesion char-
acteristics at baseline and at the 6-month visit are
shown in Table 2.
Lesions were stable in the 4 patients older than 1 year,
whereas in all patients younger than 1 year, worsening
of the lesion had been noted before treatment. In none
of the cases improvement of the lesion was noted before
treatment. No patient had been born prematurely, and
none had ongoing cardiac or obstructive pulmonary
disease. Concurrent extraocular localization of heman-
giomas was present in 3 cases (21.4%; in 1 case at the
abdomen, in 1 case at the neck, and in 1 case at the
thigh). In no case was a previous steroid or alternative
treatment administered.
Treatment was discontinued in 1 case (age 7 months)
after 2 months because of arterial hypotension, and in 1
case (age 4 years) after 3 months because of a skin rash
observed during the course of therapy. The patient with
arterial hypotension improved 1 hour after discontinuation
of treatment.
Mean treatment duration was 2.5 ⫾ 1.3 months (range,
1 to 4 months) for the 12 patients who completed
treatment before analysis. A total of 14 eyelid hemangio-
mas were analyzed: 10 (71.4%) on the upper eyelid, and 4
(28.6%) on the lower eyelid.

VOL. 155, NO. 1 PROPRANOLOL FOR INFANTILE CAPILLARY HEMANGIOMA OF THE EYELID 167
FIGURE 2. Photographs showing upper eyelid infantile capillary hemangioma in a 72-month-old patient undergoing 4 months of
oral propranolol treatment (Patient 7). Echographic examination showed involvement of the upper eyelid levator muscle. (Left)
Before propranolol treatment astigmatism was present and globe displacement was notable. (Right) At the 2-month follow-up visit
after stopping propranolol, incomplete regression of the lesion was present, but resolution of the astigmatism was obtained. At the
6-month visit, no further changes were noted.
In 13 of 14 cases, hemangiomas were superficial; in 1
case, the hemangioma involved the upper eyelid levator
muscle. In all cases, a rapid reduction in the size, with
flattening and lighter coloration at the 1-week visit, was
observed (Figure 1; Table 2). The mean follow-up
duration was 10.64 ⫾ 8.7 months (range, 6 to 39
months).
The median VAS at the 6-month visit was 97 and 98 for
evaluators 1 and 2, respectively (Table 2). A significant
agreement in the VAS assessment as a response to pro-
pranolol treatment was present between the 2 observers
(intraclass correlation coefficient, 0.97; P ⬍ .001). Ultra-
sonographic regression with a decrease in lesion thickness
was observed in all cases after a mean of 1.2 ⫾ 0.3 months.
Ptosis was present in 6 patients (42.8%; Figures 1 and 2).
Four patients (28.6%) had occlusion amblyopia, whereas 4
patients (28.6%) had amblyopia owing to anisometropic
astigmatism. The mean astigmatism value in the affected
eye decreased from 1.25 ⫾ 0.5 diopters before treatment to
0.25 ⫾ 0.2 diopters at the last visit.
Amblyopia improved in all cases based on the results
of fixation preference and visual diagnostic testing. To
date, no recurrence after propranolol discontinuation
was observed.
DISCUSSION
THIS PROSPECTIVE STUDY REPORTED ON TREATMENT OF IN-
fantile eyelid capillary hemangiomas with oral propranolol. A
dramatic effectiveness, low incidence of side effects, and no
recurrences after termination of therapy were observed. Few
retrospective studies on periocular infantile capillary heman-
giomas have been reported. Al Dhaybi and associates re-
ported recurrence of the lesion in 1 patient 6 weeks of age
(5.5%) from among 18 patients,11 whereas Missoi and asso-
ciates reported mild rebound growth that did not necessitate
treatment in 2 (12%) of 19 lesions, but none had significant
enlargement.12 Thoumazet and associates reported a recur-
rence rate of 0% in their series of 8 patients, with a follow-up
of 14 months on average.13
The recurrence rate of capillary hemangiomas after
propranolol seems inversely correlated with age because of
the high proliferative rate of the lesion in younger pa-
168 AMERICAN JOURNAL
tients.11 In our series, no patient was younger than 2
months, and this could explain the absence of recurrences.
Complete regression of the lesion was observed in 9
(64.3%) of 14 patients, and all of them were younger than
1 year. Of the remaining 5 patients who did not demon-
strate complete regression, 4 were older than 1 year. Age at
treatment onset has been suggested to influence final
outcome, because lesions in the proliferative phase are
more susceptible to propranolol.11
In our series, 2 patients were older than 5 years. In both
cases, a significant although incomplete regression of the
mass was observed. Previous studies report a mean age at
treatment onset of less than 1 year because of the supposed
greater effect of propranolol on proliferative capillaries. In
the study by Al Dhaybi and associates, infantile capillary
hemangiomas were classified according to the evolution or
stabilization of growth pattern in a proliferative phase and
in a postproliferative phase.11 Two patients with an age at
treatment onset of 30 and 31 months were included, and
their regression was poorer compared with that of patients
younger than 1 year (39% in the postproliferative phase
group vs more than 50% in the proliferative phase group).
One of the 2 patients underwent surgery for the residual
infantile capillary hemangioma. Aletaha and associates
reported successful treatment of orbital hemangioma with
propranolol in a 5-year-old girl.14 After 8 months of
treatment with oral propranolol at a dose of 2mg/kg daily,
the mass reduced significantly and regrowth was not
observed. According to our results, propranolol may rep-
resent a valid therapeutic option even after 5 years of age.
Propranolol treatment was administered during a maxi-
mum period of 4 months. In 9 (90%) of 10 patients
younger than 1 year at treatment onset, a significant
regression was obtained. In patients older than 1 year (23,
48, 72, and 96 months of age), a regression of infantile
capillary hemangioma was present, although it was incom-
plete. In previous studies, despite a longer mean duration
of treatment,11–14 final regression in patients older than 1
year was not obtained.11,14 According to our results, 4
months of treatment seem sufficient for complete regres-
sion of infantile capillary hemangiomas in patients younger
than 1 year. In older patients, a longer duration of
treatment does not seem to be correlated with a propor-
tionally greater regression of lesions.
OF OPHTHALMOLOGY JANUARY 2013
 Astigmatism induced by the distortion of the cornea is the
most common cause of amblyopia associated with periocular
infantile capillary hemangiomas.15 In our series, astigmatism
was present in 4 cases and decreased to a nonamblyogenic
level after treatment. According to these results, treatment of
sight-threatening periocular infantile capillary hemangiomas
should be started early and before amblyopia develops.
In the present study, we observed arterial hypotension in
one case and a skin rash during the course of therapy in
another case. The skin rash was considered an allergic
cutaneous reaction to propranolol. In both patients, treat-
ment was discontinued. Propranolol is a nonselective
␤-blocker, and its known side effects include bronchos-
pasm, hypoglycemia, mood disturbances, somnolence, bra-
dycardia, and hypotension.7,16 –21 A 40-year review of
propranolol toxicity in children found no cases of mortal-
ity, and in all cases, adverse effects resolved either spon-
taneously or when the drug was stopped.22,23 The potential
for the above adverse events requires adequate education
of the parents and caution on the part of the prescribing
physician. Propranolol should be discontinued during in-
tercurrent illness.
In conclusion, oral propranolol was effective in the
treatment of eyelid infantile capillary hemangiomas, and
the complication rate in this study was low. Although a
greater effect was present in infants, patients older than 5
years also benefited from propranolol treatment. Treat-
ment duration of 4 months seems sufficient to obtain the
maximum effectiveness. A randomized study is planned to
assess these data.

ALL AUTHORS HAVE COMPLETED AND SUBMITTED THE ICMJE FORM FOR DISCLOSURE OF POTENTIAL CONFLICTS OF
interest and none were reported. Involved in Design of study (P.V., A.M.); Conduct of study (P.V., A.D.M.); Collection, management, analysis, and
interpretation of data (P.V., R.F., A.M.); and Preparation, review, or approval of manuscript (P.V., R.F., A.D.M., A.M.). The Institutional Review Board
of the University Federico II, Naples, Italy, approved the prospective evaluation of effectiveness and safety of systemic propranolol for eyelid
hemangiomas. The authors are in compliance with the Health Insurance Portability and Accountability Act. Informed Consent statements for both the
treatment and participation in the research were obtained in accordance with institutional review board approval. Clinical trials registration was not
needed. The study was conducted in accordance with ethical principles stated in the Declaration of Helsinki.

REFERENCES 10. Pope E, Krafchik BR, Macarthur C, et al. Oral versus

1. Weiss AH, Kelly JP. Reappraisal of astigmatism induced by
periocular capillary hemangioma and treatment with intral-
esional corticosteroid injection. Ophthalmology 2008;115(2):
390 –397.
2. Nguyen J, Fay A. Pharmacologic therapy for periocular
infantile hemangiomas: a review of the literature. Semin
Ophthalmol 2009;24(3):178 –184.
3. Bruckner AL, Frieden IJ. Infantile hemangiomas. J Am Acad
Dermatol 2006;55(4):671– 682.
4. Frieden IJ, Haggstrom AN, Drolet BA, et al. Infantile
hemangiomas: current knowledge, future directions: proceed-
ings of a research workshop on infantile hemangiomas, April
7–;9, 2005, Bethesda, Maryland, USA. Pediatr Dermatol
2005;22(5):383– 406.
5. Bennett ML, Fleischer AB Jr, Chamlin SL, et al. Oral
corticosteroid use is effective for cutaneous hemangiomas: an
evidence based evaluation. Arch Dermatol 2001;137(9):
1208 –1213.
6. Ezekowitz RA, Mulliken JB, Folkman J. Interferon alfa2a
therapy for life-threatening hemangiomas of infancy. N Engl
J Med 1992;326(22):1456 –1463.
7. Sans V, de la Roque ED, Berge J, et al. Propranolol for severe
infantile hemangiomas: follow-up report. Pediatrics 2009;
124(3):423– 431.
8. Léauté-Labrèze C, Dumas de la Roque E, Hubiche T, et al.
Propranolol for severe hemangiomas of infancy. N Engl J Med
2008;358(24):2649 –2651.
9. American Academy of Ophthalmology Pediatric Ophthalmol-
ogy/Strabismus Panel. Preferred Practice Pattern Guidelines:
Pediatric Eye Evaluations: Screening and Comprehensive Oph-
thalmic Evaluation. San Francisco, CA: American Academy of
Ophthalmology; 2007.
high-dose pulse corticosteroids for problematic infantile
hemangiomas: a randomized controlled trial [report online].
Pediatrics 2007;119(6):1239 –1247.
11. Al Dhaybi R, Superstein R, Milet A, et al. Treatment of
periocular infantile hemangiomas with propranolol: case
series of 18 children. Ophthalmology 2011;118(6):1184 –
1188.
12. Missoi TG, Lueder GT, Gilbertson K, Bayliss SJ. Oral
propranolol for treatment of periocular infantile hemangio-
mas. Arch Ophthalmol 2011;129(7):899 –903.
13. Thoumazet F, Léauté-Labrèze C, Colin J, Mortemousque B.
Efficacy of systemic propranolol for severe infantile haeman-
gioma of the orbit and eyelid: a case study of eight patients.
Br J Ophthalmol 2012;96(3):370 –374.
14. Aletaha M, Salour H, Bagheri A, Raffati N, Amouhashemi
N. Successful treatment of orbital hemangioma with pro-
pranolol in a 5-year-old girl. Orbit 2012;31(1):18 –20.
15. Frank RC, Cowan BJ, Harrop AR, et al. Visual development
in infants: visual complications of periocular haemangiomas.
J Plast Reconstr Aesthet Surg 2010;63(1):1– 8.
16. Lawley LP, Siegfried E, Todd JL. Propranolol treatment for
haemangioma of infancy: risks and recommendations. Pediatr
Dermatol 2009;26(5):610 – 614.
17. Holland KE, Frieden IJ, Frommelt PC, Mancini AJ, Wyatt D,
Drolet BA. Hypoglycemia in children taking propranolol for
the treatment of infantile haemangioma. Arch Dermatol
2010;146(7):775–778.
18. Léauté-Labrèze C, de la Roque ED, Taïeb A. More on
propranolol for haemangiomas of infancy. N Engl J Med
2008;359(26):2846 –2847.
19. Buckmiller LM, Richter GT, Suen JY. Diagnosis and man-
agement of haemangiomas and vascular malformations of the
head and neck. Oral Dis 2010;16(5):405– 418.

VOL. 155, NO. 1 PROPRANOLOL FOR INFANTILE CAPILLARY HEMANGIOMA OF THE EYELID 169
20. Holmes WJM, Mishra A, Gorst C, Liew SH. Propranolol as
first-line treatment for rapidly proliferating infantile haeman-
giomas. J Plast Reconstr Aesthet Surg 2011;64(4):445– 451.
21. Tan ST, Itinteang T, Leadbitter P. Low-dose propranolol for
infantile haemangioma. J Plast Reconst Aesth Surgery 2011;
64(3):292–299.
22. Mishra A, Holmes WJM, Gorst C, Liew SH. Role of
propranolol in the management of periocular haemangiomas.
Plast Refract Surg 2010;126(2):671.
23. Love JN, Sikka N. Are 1–2 tablets dangerous? Beta-
blocker exposure in toddlers. J Emerg Med 2004;26(3):
309 –314.

170 AMERICAN JOURNAL OF OPHTHALMOLOGY JANUARY 2013

 Biosketch
Patrizia Vassallo, MD, is a consultant surgeon ophthalmologist at the University of Naples Federico II, Naples, Italy. She
has been working for 30 years in the Orbital Unit, lead by Professor Giulio Bonavolonta. Dr Vassallo has been chief
consultant at the pediatric ophthalmology outpatient service for the last 10 years. Her main research interests are orbital
and eyelid diseases.

VOL. 155, NO. 1 PROPRANOLOL FOR INFANTILE CAPILLARY HEMANGIOMA OF THE EYELID 170.e1
 Biosketch
Raimondo Forte, MD, PhD, is consultant surgeon ophthalmologist at the University Federico II of Naples, Italy and at
the University of Salerno, Italy. He earned his MD and PhD degrees, and a postdoctoral fellowship from the University
of Naples Federico II. Dr Forte has contributed to more than 60 peer-reviewed articles, mainly in the areas of imaging of
AMD and ophthalmic neoplastic diseases. His main research interests are medical retinal diseases and chorioretinal
tumors.

170.e2 AMERICAN JOURNAL OF OPHTHALMOLOGY JANUARY 2013