Spontaneous bleeding of a hidden deep orbital hemangioma following routine retinopathy of prematurity screening examination

To report a rare case of spontaneous bleeding in a hidden orbital deep infantile hemangioma (IH) presenting with acute swelling and ptosis following retinopathy of prematurity (ROP) screening. A 2-month-old baby presented with progressive swelling in the left medial canthus and glabella immediately following a ROP screening. Ophthalmological evaluation revealed swelling in the superior nasal region of the left eye, causing ptosis, with an underlying superficial lesion on the forehead. Spontaneous hemorrhage was considered, prompting Pediatric Cardiology consultation. Ultrasound demonstrated a highly vascularized, hypoechoic lesion (3 × 1 cm) extending from the supraorbital region. The patient was diagnosed with orbital mixed IH, and oral propranolol therapy (1 mg/kg, twice daily) was initiated. ROP screening tools (speculums/indenters) may induce spontaneous bleeding in underlying orbital IH. Early identification of vision-threatening orbital hemangiomas and prompt pediatric cardiology consultation for systemic propranolol are critical for preventing amblyopia and optimal functional outcomes.

Keywords: Infantile hemangioma, Orbital hemangioma, Retinopathy of prematurity screening, Retinopathy of prematurity, Spontaneous bleeding