Paediatric Ophthalmology:
                    Case seventeen

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Figure 1

Figure 2

This 6 month-old baby was referred by the paediatrician because of the above appearance.

a. What is the diagnosis?

Capillary haemangioma (strawberry naevus)
There are multiple red nodules involving the lids and face. These are not present at birth but usually appears between the first and fourth week of life.

b. What ocular and systemic complications may occur?

Ocular complications:

• deprivation amblyopia can occur if there were significant ptosis
• extension of the lesion into the orbit can lead to refractive error, proptosis, strabismus and optic nerve compression

Systemic complication:

• platelet consumption can occur with large lesion causing thrombocytopenia (Kasbach-Merritt syndrome)

c. How would you manage the patient?

Due to the risk of amblyopia, the patient should be refracted and vision assessed at regular interval.

As the lesions typically resolve spontaneously by the age of  7, no treatment may be required apart from regular followed up to detect any ocular complications such as amblyopia. However, if there were risk of deprivation amblyopia due to ptosis or significant cosmetic disfigurement the following treatment could be used:

• intralesional steroid injection (such as triamcinolone) can reduce the size of the tumour and speed up resolution (this procedure was carried out in this patient, figure 2 is taken at age 5)
• radiotherapy and surgical debulking are rarely used as they cause significant scarring