Cavernous Haemangioma of Eyelid is a hamartoma, which arises usually after the second decade of life. Eyelid lesion is less common as compared to orbital tumour. It usually accompanies the orbital tumour and the occurrence of isolated eyelid lesion is rare. Cavernous hemangioma represents a hamartoma that seldom appears prior to middle childhood, with the majority arising after the second decade. Although this lesion is the most common benign orbital tumor in adults, it only occasionally occurs as an isolated eyelid lesion. A rare syndrome termed the blue rubber bleb nevus syndrome, exists which is characterized by multiple cutaneous cavernous hemangiomas associated with gastrointestinal hemangiomas that often bleed.
A subtype of cavernous hemangioma, termed sinusoidal hemangioma, has been described to involve the eyelid with a more aggressive growth pattern invading adjacent areas of the brow and cheek.
Blue rubber bleb naevus syndrome, a rare entity, is characterised by multiple cutaneous cavernous haemangiomas associated with gastrointestinal haemangiomas which often bleed.
Superficial skin lesions are slow growing, dark blue, lobulated, compressible lesions. When large they can cause amblyopia from ptosis with obstruction of the visual axis, and from astigmatism from ocular compression. Unlike their orbital counterpart, isolated superficial hemangiomas are not encapsulated.
The hemangioma is dark blue, compressible, lobulated lesion which increases slowly in size.
These lesions may produce amblyopia due to mass effect of ptosis or from astigmatism produced by ocular compression.
HISTOPATHOLOGY: Cavernous haemangiomas show endothelium lined, large dilated blood filled spaces. These vascular spaces are separated by fibrous stroma. These tumours are well circumscribed but are not encapsulated. There may be signs of focal chronic inflammation. There is no endothelial proliferation unlike acquired capillary haemangioma of eyelid. There may be thrombosis or foci of calcification.
The differential diagnosis includes
Acetic acidum - Acetic acid has the power to liquefy albuminous and fibrinous deposits
Carcinosinum -Carcinosin acts favorably and modifies all cases in which either a history of carcinoma.
Fluroicum acidum - Lachrymal fistula. Violent itching of inner canthis, Especially adapted to chronic diseases with syphilitic and mercurial history. red edges and vesicles. Decubitus; worse, warmth. Syphilitic rupia. Itching of cicatrices. Feels as if burning vapor were emitted from pores. Itching especially of the orifices, and in spots, worse warmth.
Thuja occidentalis-spongy tumors is very important. Moist mucous tubercles. Bleeding fungus growths. Nævus. Excess of venosity, Ill-effects of vaccination. Sycotic pains, i.e, tearing in muscles and joints, worse at rest, better in dry weather, worse damp humid atmosphere; lameness. Hydrogenoid constitutions, whose blood is morbidly hydroscopic, so that damp air and water are inimical. Large, flat phlyctenules; indolent. Recurring episcleritis. Chronic scleritis.
Staphysagria: Recurrent styes. Chalazæ (Platanus). Eyes sunken, with blue rings. Margin of lids itch. Affections of angles of eye, particularly the inner. Lacerated or incised wounds of cornea. Bursting pain in eyeballs of syphilitic iritis.