A 3-month-old girl has a bright red, lobulated vascular lesion over the upper eyelid that appeared at 2 weeks of age and has grown rapidly. It is partially obstructing the visual axis and the cornea shows astigmatism on refraction. What is the most appropriate management?

• A Pulsed dye laser ablation
• B Reassurance and serial photography
• C Oral propranolol ✓
• D Intralesional corticosteroid injection

Explanation

Periocular infantile hemangiomas threatening vision (amblyopia risk from occlusion or astigmatism) require systemic propranolol at 2 to 3 mg/kg/day, which induces early involution. Observation is reserved for small, uncomplicated lesions away from vital structures because most involute spontaneously by 5 to 10 years. Laser treats superficial residual telangiectasia but does not address deep components, and steroids are now second line.

Reference: Nelson Textbook of Pediatrics, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.