To identify clinical factors associated with complications of periocular infantile hemangioma (IH) and monitor improvement in complication rates post‐treatment.

Retrospective cohort study. Eighty‐nine patients diagnosed with periocular IH at a pediatric dermatology clinic of a tertiary care center between 2001 and 2013 were included with parental approval. Parents were interviewed by telephone between July and September of 2015, then again in January 2018 to inquire about ophthalmologic follow‐up. Electronic medical records were reviewed from January 2001 through January 2018.

Sixty percent of patients demonstrated ocular sequelae, including astigmatism (33%), visual axis obstruction (29%), nasolacrimal duct obstruction (7%), ptosis (4%), amblyopia (3%), and strabismus (1%). Compared with superficial IH, deep and mixed IH had higher odds, 3.4 (P = 0.025) and 3.8 (P = 0.034), respectively, of developing ocular sequelae. All patients with astigmatism prior to involution of IH received systemic therapy, with a significant post‐treatment decrease in the proportion of patients with astigmatism (40% to 18%, P = 0.027). Three‐quarters of patients experienced complete IH involution by time of enrollment in kindergarten. Fifty‐one (57.3%) patients received formal ophthalmologic evaluation confirmed through chart review or phone interview, with average follow‐up duration of 51.2 months (range: 1.9, 99.3).

Deep and mixed IH were more likely to demonstrate ocular complications than superficial IH. Rate of astigmatism decreased with systemic therapy. Our study suggests that patients with periocular IH have a lower rate of amblyopia now compared with the prepropranolol era and emphasizes the importance of early treatment of periocular IH to prevent permanent visual sequelae.