• Oculoplastics/Orbit

    Findings from a small case series suggest that ocular surface pyogenic granulomas (PGs) may be resolved with topical timolol treatment, which causes fewer adverse effects than conventional topical steroid treatments or other medical or surgical therapies.

    Interest in topical β-blockers for PGs follows the success of these drugs for treatment of infantile hemangiomas. Several previous reports have shown timolol to be an effective alternative in treating nonocular pyogenic granulomas. However, there is limited information surrounding the use of timolol in ocular PGs. Only 1 study reported incidental resolution of an ocular surface PG 6 months after initiation of topical timolol-dorzolamide for glaucoma.

    Study design

    Using patient medical records, investigators identified 4 consecutive children aged 3 to 9 years with acquired ocular surface PGs treated at Boston Children’s Hospital. Patients exhibited PGs secondary to inflammation related to chalazia in 2 cases, surgical trauma in 1 case, and unintentional trauma in 1 case. Patients were treated with topical timolol 0.5%, twice daily for a minimum of 21 days.

    Outcomes

    Complete resolution occurred within the treatment period with no recurrence for at least 3 months in all patients. One patient had a residual chalazion after timolol treatment but did not require surgery. There were no adverse effects from the timolol during follow-up.

    Clinical significance

    Despite the absence of a control group and the limited number of patients, this treatment option could provide an alternative approach that minimizes risks compared with traditional surgical or steroid therapies. This is especially important for children, who are at highest risk for these lesions, and would allow physicians to avoid anesthesia and IOP monitoring in this vulnerable population.