Hemangioma eye is a benign vascular tumor located on the skin of the eyelids or conjunctiva and consisting of pathological vascular plexuses. The causes of hemangioma of the eye are not exactly known. There are capillary and cavernous hemangiomas, as well as mixed variants. Clinical manifestations depend on the type of hemangioma. Diagnostics is carried out using visual examination and biomicroscopy, additional methods include ultrasound of the eye, MRI or CT of the orbits, angiography. Treatment is carried out conservatively or operationally, depending on the size and location of the hemangioma. With early treatment and proper treatment, the prognosis is favorable.
General information
Hemangioma of the eye is a benign vascular neoplasm arising from hyperplastic endothelium of blood vessels, which manifests itself mainly in childhood, is characterized by fairly rapid growth and frequent germination into surrounding tissues. Hemangioma of the eye is one of the most common benign tumors in pediatric ophthalmology. It occurs in newborns, more often in premature babies. It is detected in the first days after the birth of a child or in the first months of life. Girls get sick more often than boys. The highest incidence is observed in children from developed countries. If a child has a hemangioma of the eye, then during the first six months of life, such children may have hemangiomas on other parts of the body. Being morphologically benign formations, hemangiomas often have an unfavorable clinical course and are characterized by rapid infiltrating growth, reaching a maximum value in the first weeks and months of life.
Causes
The causes of hemangiomas of the eye still cause a lot of controversy among ophthalmologists. Currently, specific gene mutations responsible for the development of ocular hemangioma have not yet been found, heredity is not a risk factor. The exact mechanisms triggering disorders in angiogenesis (the process of formation and development of new vessels) are unknown. There is some evidence that the hemangioma of the eye in newborn children is formed as a result of damage to angioblasts (vascular wall cells). These processes occur in the first trimester of pregnancy, between 7 and 10 weeks. The process of intrauterine vascular development is quite complex and has not been fully studied. Any changes in angiogenesis can lead to spontaneous growth of blood vessels, noted with hemangiomas of the eye in children.
Symptoms
There are capillary and cavernous hemangioma of the eye, as well as mixed variants. Capillary hemangioma, or “strawberry” nevus, is manifested in newborns in the form of a limited tumor-like growth of bright red color. It protrudes above the skin level, turns pale when pressed and increases in size during the cry or crying of a child. It is more common on the upper eyelid and can spread into the orbit. In this type of hemangioma, active growth is noted in the first year of a child’s life and stops by the age of two. Then there is a reverse regression of the tumor with complete disappearance by 5-6 years. In rare cases, hemangioma of the eye can be combined with lesions of other organs and systems in the form of Kazabach-Merritt syndrome (characterized by thrombocytopenia, anemia and blood clotting disorders), or Maffucci syndrome (combined with chondromatosis of the arms, legs and curvature of the tubular bones).
Cavernous hemangioma, or “flaming” nevus, manifests itself as a spot, clearly delimited, soft in consistency, pink in color, not paling when pressed. They also occur in newborns. With age, it does not increase in size and does not pass on its own, the color of the spot changes to dark red or purple. The skin under the formation may become rough, hypertrophied, become knobby, loose, bleed or inflamed. The lesion is segmental in nature, but there are also bilateral nevi. Combined lesions occur with extensive hemangiomas affecting branches of the trigeminal nerve. They manifest themselves in the structure of the Sturge-Weber syndrome (characterized by a violation in the development of retinal vessels and brain membranes).
Of the complications of hemangiomas of the eye, there are: mechanical ptosis (the large size of the tumor interferes with the normal functioning of the eyelid muscles), as a result of ptosis, obscuration amblyopia develops; strabismus (a neoplasm in the eye area prevents the full movement of the eyeball in any direction). A scar or hypopigmentation may remain in place of the regressed tumor. Large-sized hemangiomas of the eye can be complicated by bleeding, infection or suppuration.
Diagnosis
Diagnosis of all types of hemangiomas of the eye usually does not cause difficulties and is based on a visual examination of the child by an ophthalmologist using the method of biomicroscopy using a slit lamp. To clarify the diagnosis and differential diagnosis with other vascular tumors, additional studies are carried out, such as ultrasound of the eyeball (to clarify the structure and depth of the spread of hemangioma), CT orbits or MRI (in case of insufficient ultrasound data, to clarify the size of the neoplasm and possible damage to neighboring organs).
If surgical treatment of an eye hemangioma is necessary, angiography is additionally performed to more accurately determine the boundaries of the tumor and the spread of pathological vessels. If the hemangioma surface, color or consistency changes, a biopsy is performed to exclude malignant degeneration of the neoplasm. Consultations with an oncologist, dermatologist, hematologist or an infectious disease specialist may also be prescribed.
Treatment
In the treatment of hemangioma, a conservative or surgical method is used. Conservative therapy includes the use of drugs from the group of glucocorticosteroids (the drug is administered orally to a child at the first manifestations of a neoplasm), interferons (subcutaneous administration of the drug is used for extensive hemangiomas). With small sizes of the hemangioma of the eye, the method of cryodestruction or diathermocoagulation is used for removal (exposure to the hemangioma with low or high temperature, resulting in destruction and rejection of the neoplasm). The use of laser techniques is also justified for small sizes of hemangioma of the eye. Surgical treatment is indicated for extensive hemangiomas located in anatomically complex areas. In addition, the surgical method is used to remove cosmetic defects left over from hemangiomas.
With timely treatment to an ophthalmologist with the first signs of hemangioma formation, correctly selected therapy – the prognosis is favorable, it is possible to achieve complete disappearance of the neoplasm without visible defects.
Prevention
Considering that hemangiomas of the eye are laid at the embryonic stage, preventive measures include careful monitoring and examination of women both during pregnancy and at the stage of preparation for conception. A few months before conception, it is necessary to undergo treatment for all chronic foci of infection (ENT organs, eyes, teeth). It is mandatory to inform women about the dangers of smoking and alcohol during pregnancy, to release a pregnant woman from work in harmful chemical industries in a timely manner or to transfer to easier work. In women over 35-40 years of age, it is necessary to carefully monitor blood pressure to prevent the occurrence of eclampsia. If a newborn has an eye hemangioma, it is necessary to contact an ophthalmologist as soon as possible for examination and clarification of the diagnosis, as well as strictly follow the doctor’s recommendations.
