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September 2013

Deep Periocular Infantile Capillary Hemangiomas Responding to Topical Application of Timolol Maleate, 0.5%, Drops

Author Affiliations
  • 1Pediatric Ophthalmology Service, Prince Charles Eye Unit, King Edward VII Hospital, Windsor, and Royal Berkshire NHS Foundation Trust, Reading, England
JAMA Ophthalmol. 2013;131(9):1246-1248. doi:10.1001/jamaophthalmol.2013.4171

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.