Topical timolol shows promise in treating infantile capillary haemangiomas

Topical timolol maleate 0.5 per cent gel seems to be safe and effective in the treatment of deep periocular capillary haemangiomas and may provide a viable alternative when systemic propranolol treatment is contraindicated, according to a presenter at the 2013 SOE Congress in Copenhagen, Denmark. 'Periocular infantile capillary haemangiomas (IH) can cause visual impairment as well as facial disfigurement,' explained Kanmin Xue, King Edward VII Hospital, Prince Charles Eye Unit, Windsor, UK. 'Oral propranolol is increasingly used as first-line therapy for IH. While propranolol is usually well tolerated by infants, adverse reactions could occur in around seven per cent of cases. A growing body of evidence suggests that the topical beta-blocker, timolol maleate, is also effective in the treatment of superficial IH but with fewer adverse effects,' he said. Noting that almost all published reports so far have focused on topical timolol treatment of superficial IH, Dr Xue presented the results concerning two infants with deep periocular IH treated with topical timolol alone. Case 1 was a seven-week-old with a deep IH involving the whole left upper lid, causing lid closure, astigmatism and amblyopia, while the second case was a six-month-old with a 15 x 20mm medial right lower lid IH, causing limitation of adduction in depression of the right eye. Both were treated with topical timolol maleate 0.5 per cent gel three drops applied twice daily to the skin. In both cases, topical timolol treatment led to near complete involution of the deep capillary haemangiomas with functional recovery of vision and satisfactory cosmesis. Case 1 received one year of topical timolol treatment and achieved equal visual acuity of 6/7.5 in each eye. No evidence of recurrence was seen after cessation of treatment for five months at the last follow-up. Case 2 was treated for 11 months and achieved visual acuity of 6/9 in each eye with full range of extraocular movements and no adverse reaction was seen, concluded Dr Xue.