Infantile (capillary) hemangiomas are common in the eyelids of children. They usually appear shortly after birth as a bright red lesion, grow over weeks to months, and involute by school age. Intervention is reserved for lesions that affect vision because of ptosis or astigmatism, leading to amblyopia.
The histologic appearance depends on the stage of evolution of the hemangioma. Early lesions may be very cellular, with solid nests of plump endothelial cells and correspondingly little vascular lumen formation. Established lesions typically show well-developed capillary channels lined with plump endothelial cells in a lobular configuration (Fig 13-20). Involuting lesions demonstrate increased fibrosis and hyalinization of capillary walls with luminal occlusion. β-Blockers are often used as first-line treatment of capillary hemangiomas, usually with significant reduction in size. Excision of these lesions should be performed with care because it can lead to significant blood loss from the large feeder vessels that are present within the hemangiomas.
Excerpted from BCSC 2020-2021 series: Section 4 - Ophthalmic Pathology and Intraocular Tumors. For more information and to purchase the entire series, please visit https://www.aao.org/bcsc.