TOACS FCPS Station · Large Facial Hemangioma Obstructing Vision

📷 Clinical Photograph – Large Facial Hemangioma

Clinical photograph showing a large facial hemangioma involving the periocular area, obstructing vision

Figure 1 · Facial hemangioma · Infantile Hemangioma – Periocular

🔍 Key clinical features:

✓ Bright red, protuberant mass involving the periocular region
✓ Eyelid involvement – obstructing the visual axis
✓ Rapid growth – typical of proliferating infantile hemangioma
✓ Risk of amblyopia (deprivation or strabismic)
✓ High-risk hemangioma – requires urgent treatment

📋 Clinical scenario (examiner prompt)

A 3‑month‑old infant presents with a rapidly growing red mass on the left side of the face, first noticed at 2 weeks of age. The lesion now involves the upper and lower eyelids, obstructing the visual axis. The infant is otherwise healthy and feeding well. The parents are concerned about the “bump” and whether the baby can see.

Rapid growth Obstructing vision Eyelid involvement Amblyopia risk

🧑‍⚕️ Examiner tasks · TOACS

1. Identify the diagnosis from the clinical image and history.

2. Describe the clinical features (rapid growth, periocular involvement, visual axis obstruction).

3. Explain the pathophysiology (infantile hemangioma, GLUT-1+, proliferative phase).

4. Discuss management (urgent propranolol, ophthalmology, PHACES evaluation).

⚠️ Key concept: A periocular infantile hemangioma obstructing the visual axis is a high‑risk lesion that requires urgent treatment to prevent amblyopia (permanent vision loss). Oral propranolol (2‑3 mg/kg/day) is the first‑line therapy. A segmental facial hemangioma >5cm mandates evaluation for PHACES syndrome.

🎯 Expected answers (for examiners)

• Diagnosis: Periocular infantile hemangioma (high-risk)
• Clinical features: Bright red mass, eyelid involvement, visual axis obstruction, rapid growth
• Pathophysiology: GLUT-1+ endothelial proliferation; proliferative phase in first months
• Management: Oral propranolol (2‑3 mg/kg/day), ophthalmology (urgent), MRI/MRA if PHACES suspected

⚡ Quick FCPS‑style MCQ

A 3‑month‑old with a periocular hemangioma obstructing the visual axis should be treated with:

A. Observation only B. Oral propranolol C. Topical timolol D. Surgical excision

📌 Topic summary ·

Infantile hemangioma
GLUT-1+, proliferates first 6‑9 months

High-risk
Periocular, airway, large facial, PHACES

First-line
Oral propranolol (2‑3 mg/kg/day)

PHACES
Posterior fossa, Arterial, Coarctation, Eye, Sternal

Amblyopia risk
Eyelid obstruction → urgent treatment

Ophthalmology
Essential for visual outcome

Feature	Periocular Hemangioma
Onset	First weeks, rapid growth in proliferative phase
Risk	Amblyopia (deprivation, strabismus), astigmatism
Treatment	Oral propranolol (first‑line)
Ophthalmology	Urgent referral, monitor for visual axis obstruction
PHACES	Evaluate if segmental, >5cm

🩻 TOACS FCPS Station · Large Facial Hemangioma Obstructing Vision

📷 Clinical Photograph – Large Facial Hemangioma

🧑‍⚕️ Examiner tasks · TOACS

📌 Topic summary ·