Abstract
Purpose: :
Benign vascular tumors of the eyelid are common causes of ocular morbidity. Capillary hemangiomas are the most common orbital tumors of childhood occurring in 1-3% of term newborns. Corticosteroid therapy of benign vascular lesions risks sight-threatening complications including central retinal artery occlusion and significant systemic morbidity. Alternatively, oral and intravenous beta-blockers have been reported to induce regression of these lesions. One recent report documented the efficacy of topical timolol in treating a large capillary hemangioma of the eyelid in a child. Topical application reduces the potential for systemic side effects of beta-blockers including bradycardia, hypotension, heart block, and bronchospasm. However, there are no reports on the effects of beta-blockers for similar lesions in adults. This study investigates whether topical Timolol 0.5% solution applied twice daily causes significant regression of benign vascular periocular lesions in adults.
Methods: :
Prospective case series of patients with benign vascular periocular lesions from Loyola University Health System. Inclusion criteria: 1) Presence of a benign vascular periocular lesion. Exclusion criteria: 1) Allergy or contraindication to timolol or beta-blocker. 2) Intraocular pressure less than 10 mmHg. 3) Lesion characteristics concerning for atypia or malignancy. 4) Patient less than 18-years-old. Patients were enrolled, and photo documentation of lesion morphology was obtained. Patients were given a 15 mL bottle of timolol 0.5% ophthalmic solution to apply to the lesion(s) twice daily via topical massage. Patients were followed at monthly intervals for 3 months or until lesion resolution. Photo documentation of final lesion morphology was obtained. Pre-treatment and post-treatment lesion sizes were compared.
Results: :
14 lesions met criteria, were treated with topical timolol, and were followed for 1 to 3 months. None of the lesions regressed with therapy. One patient reported mild sensitivity with treatment. No other side effects were reported.
Conclusions: :
Our study refutes the hypothesis that Topical timolol 0.5% solution applied twice daily facilitates regression of benign vascular periocular lesions in adults. The lack of response to therapy of adult lesions in our trial differs markedly from the responses reported in children with capillary hemangiomas and lends further credibility to the hypothesis that lesion susceptibility to beta-blockers is due to differing endothelial receptor expression in congenital and adult hemangiomas. To our knowledge, this is the first report on the effect of timolol on adult vascular periocular lesions.
Clinical Trial: :
http://www.clinicaltrials.gov NCT01250457
Keywords: tumors • clinical (human) or epidemiologic studies: treatment/prevention assessment/controlled clinical trials • eyelid