Interest of Vep in the Management of Lid Hemangiomas

Abstract

 

Purpose:

 

Lid hemangiomas in new borns are at risk of amblyopia because of the occlusion of the visual axis and also because of the astigmatism they can induce. The diagnosis of amblyopia is not always easy and can be asserted by Visual Evoked Potentials (VEP).

 

Methods:

 

We present 4 observations of children with unilateral lid hemangiomas who had VEP performed with portable achromatic flash. The implicit time of P2 was compared between both eyes. A refraction with atropine cycloplegia was performed in all patients.

 

Results:

 

VEP was performed between the age of 3 and 5 months in the 4 patients. No anisometropia of more than 1 spherical dioptre or more than 0.75 cylindrical dioptre was found in any patient but one. A difference between both eyes of more than 10 ms of the implicit time of P2 was found in 3 of the 4 patients. There was no such a difference in the 4^th patient despite a difference of visual acuity asserted by the Teller test.

 

Conclusions:

 

Diagnosis of amblyopia in new borns is asserted on a body of proof. It is very important to be sure of the diagnosis especially in the cases of lid hemangiomas, because along with the patching of the better eye, it can be an argument to begin a systemic corticosteroid therapy which is not without risks in very young children. VEP is an objective exam compared to the Teller test ; those two exams can be discordant. It is not resolved what is the significant threshold of the difference of implicit time between the two eyes. We consider a difference more than 10 ms as significant.VEP in children with lid hemangioma is an interesting tool to assess or not amblyopia.  

 

Keywords: amblyopia • electrophysiology: clinical • eyelid