A cavernous hemangioma is a benign vascular malformation, an abnormal collection of blood vessels. While found throughout the body, they frequently occur within or around the eye. Though non-cancerous, these lesions warrant attention due to their potential impact on vision and ocular function.
What is a Cavernous Hemangioma of the Eye?
A cavernous hemangioma of the eye is a slow-growing vascular lesion comprising large, dilated blood vessels that resemble interconnected caverns or spaces filled with blood. These formations are enclosed by a fibrous capsule, making them well-defined within the orbital cavity, the bony socket housing the eye. They are the most common benign vascular lesion found in the adult orbit, often presenting in individuals between 20 and 50 years of age, with a higher incidence in women.
These lesions usually develop within the muscle cone, the area surrounded by eye movement muscles, though they can appear elsewhere. Unlike some other vascular lesions, cavernous hemangiomas have slow blood flow. Their growth occurs through gradual enlargement of these vascular spaces, leading to a slow onset of symptoms.
Recognizing the Signs and Symptoms
Signs and symptoms of a cavernous hemangioma of the eye develop as the lesion expands and exerts pressure on nearby structures. A common manifestation is proptosis, a painless, progressive bulging of the eyeball. This occurs as the growing mass increases volume within the confined orbital space.
The enlarging hemangioma can press on the optic nerve or eye movement muscles, leading to various visual disturbances. Patients may experience blurred vision, reduced visual field, or double vision (diplopia). Pressure on the optic nerve can also result in damage or atrophy. Rarely, significant eye bulging may prevent eyelids from fully covering the cornea, leading to corneal exposure, keratitis, or ulceration.
Diagnosis and Treatment Approaches
Diagnosis of a cavernous hemangioma of the eye begins with a comprehensive eye examination by an ophthalmologist. Specialized tests, such as Hertel exophthalmometry, measure the degree of eye bulging. Evaluations of visual acuity, color vision, pupillary function, and extraocular muscle movement assess the lesion’s impact.
Imaging studies are crucial for confirming the diagnosis and determining the lesion’s size, exact location, and relationship to surrounding structures. Magnetic Resonance Imaging (MRI) is the preferred method, as it provides detailed images showing a well-defined, often oval-shaped mass with specific signal characteristics. Computed Tomography (CT) scans can also identify the mass and its boundaries, though MRI offers superior soft tissue contrast. In rare instances, a biopsy might be considered to definitively confirm the diagnosis and exclude other conditions.
Treatment decisions depend on the lesion’s size, location, and whether it is causing symptoms or affecting vision. For asymptomatic or stable lesions, a watchful waiting approach with regular monitoring through eye examinations and imaging is recommended. If the hemangioma is growing, causing vision problems, or leading to significant cosmetic changes, surgical removal is the primary treatment.
The surgical approach varies based on the lesion’s position; for example, anterior lesions may be accessed through the eyelid or conjunctiva, while deeper or more posterior lesions might require approaches like a lateral orbitotomy or, in rare cases, a transcranial approach. Complete surgical excision is usually the goal to prevent recurrence. Other interventions, such as radiation therapy, may be considered where surgery is not suitable.
Long-Term Outlook and Management
The long-term outlook for individuals with a cavernous hemangioma of the eye is favorable with appropriate management. For completely removed lesions, the visual prognosis is excellent, and recurrence is uncommon. Even after successful treatment, regular follow-up appointments are important to monitor for any changes or recurrence.
Ongoing management involves periodic eye examinations and imaging studies, such as MRI, to track orbital stability. While most patients experience good recovery of visual function, some may have persistent issues like hyperopia (farsightedness) if the lesion caused a lasting indentation on the back of the eye. Even those managed conservatively remain stable over many years.