Paediatric hemangiomas of right lower eyelid excision: A case study from a nursing perspective

Priyadharshini1, Anbarasi2

1Staff Nurse Kauvery Hospital, Alwarpet, Chennai, Tamil Nadu

2Nurse Educator, Kauvery Hospital, Alwarpet, Chennai, Tamil Nadu

Introduction

Infantile hemangioma is a common benign vascular tumor of infancy, which may require intervention when located near vital structures such as the eye. This nursing case study presents a 2-year-old female child admitted for excision of a right lower eyelid hemangioma. The study emphasizes clinical presentation, diagnostic evaluation, medical and surgical management, comprehensive nursing care, and family education. Holistic nursing interventions played a vital role in ensuring safe perioperative care, recovery, and parental satisfaction. Hemangiomas are the most common vascular tumors in infancy and early childhood. While many resolve spontaneously, periocular hemangiomas may interfere with vision, cause cosmetic deformity, or lead to complications such as bleeding. Early recognition and appropriate multidisciplinary management are essential. Nurses play a crucial role in assessment, perioperative care, parental counseling, and postoperative monitoring in pediatric patients.

Definition

A hemangioma is a benign vascular tumor characterized by abnormal proliferation of blood vessels. Infantile hemangiomas typically appear within the first few months of life, undergo a rapid growth phase, followed by gradual involution.

Case Presentation

A 2-year-old female child was admitted to a tertiary care hospital for surgical management of a progressively enlarging reddish lesion over the right lower eyelid. The lesion was not present at birth and appeared at around 3 months of age, gradually increasing in size. The child had a history of intermittent bleeding following minor trauma. Prior medical management and intralesional steroid therapy had been attempted at another facility with limited response. The child was admitted for definitive surgical excision.

Clinical Manifestations

  • Reddish, raised lesion over the right lower eyelid
  • Progressive increase in size
  • Occasional bleeding on minor trauma
  • Cosmetic concern and risk to ocular function
  • No systemic symptoms such as fever or lethargy

Diagnostic Evaluation

  • Detailed clinical examination of the lesion
  • Assessment of growth pattern and bleeding tendency
  • Routine preoperative laboratory investigations
  • Pediatric and anesthetic evaluation for surgical fitness
  • Vital signs monitoring and systemic examination (within normal limits).

Pre op

Investigations

MRI Images

Biopsy Report

Nursing Diagnosis

  • Impaired skin integrity related to surgical excision of hemangioma
  • Acute pain related to surgical procedure
  • Risk for infection related to surgical wound
  • Anxiety of parents related to child’s surgery and outcome

Medical Management

  • Previous conservative management with medications and intralesional steroids
  • Preoperative stabilization and infection prevention
  • Postoperative medications as prescribed (analgesics and antibiotics)
  • Monitoring for bleeding and wound complications

Nursing Management

  • Comprehensive admission assessment
  • Monitoring of vital signs and neurological status
  • Preoperative preparation and fasting as per protocol
  • Postoperative wound care and observation for bleeding
  • Pain assessment and administration of prescribed analgesics
  • Ensuring comfort and safety of the child

Nursing Interventions

  • Maintain aseptic technique during wound care
  • Monitor surgical site for bleeding, redness, or discharge
  • Assess and manage pain using age-appropriate pain scales
  • Provide emotional reassurance to the child and parents
  • Ensure safe handling to prevent trauma to the surgical site

Patient and Family Education

  • Explanation of the disease process and surgical outcome
  • Instructions on wound care and hygiene
  • Importance of medication adherence
  • Recognition of warning signs such as excessive bleeding, swelling, or fever
  • Follow-up visits and long-term monitoring advice

Outcomes

  • Successful excision of the hemangioma
  • Stable postoperative recovery
  • No immediate complications
  • Improved cosmetic appearance and reduced risk to vision

Evaluation

The child remained clinically stable throughout the hospital stay and at discharge. Parents demonstrated adequate understanding of postoperative care and follow-up instructions.

Patient Appreciation and Feedback

The child’s parents expressed satisfaction with the nursing care, clear explanations, and compassionate approach provided by the healthcare team during hospitalization.

Conclusion

This case study highlights the importance of early intervention and comprehensive nursing care in managing periocular hemangiomas in children. A multidisciplinary approach combined with vigilant nursing assessment and parental education ensures safe recovery and optimal outcomes.

References

  • Drolet BA, et al. Initiation and use of propranolol for infantile hemangioma. Pediatrics.
  • Frieden IJ, et al. Hemangiomas of infancy: current concepts. J Am Acad Dermatol.

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