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Oral propranolol hydrochloride is widely used as first-line therapy for periocular infantile capillary hemangiomas. Close monitoring is required as potentially serious adverse effects are well recognized. Recently, the topical β-antagonist timolol maleate has also been reported to be an effective treatment for superficial infantile hemangiomas (IHs). As a result, a general paradigm has emerged that topical timolol may be a good option for superficial IH, while systemic propranolol remains the treatment of choice for deep IH. We describe 2 infants with deep periocular IHs who have undergone successful primary monotherapy with topical timolol maleate, 0.5%, drops. In both cases, topical treatment alone led to near-complete involution of the IH, and the effect has been well sustained following tapering or cessation of treatment.
Xue K, Hildebrand GD. Deep Periocular Infantile Capillary Hemangiomas Responding to Topical Application of Timolol Maleate, 0.5%, Drops. JAMA Ophthalmol. 2013;131(9):1246-1248. doi:10.1001/jamaophthalmol.2013.4171