Infantile hemangioma is the most common benign tumor of infancy, occurring in 4% to 10% of children.1 Hemangiomas are usually absent at birth or present only as precursor lesions and have a characteristic natural history of rapid growth within the first 3 to 6 months of life, followed by spontaneous involution over several years.2 Most hemangiomas are asymptomatic and can be managed by observation; however, a few may cause significant complications. Periocular hemangiomas can lead to severe and permanent visual disturbances by occluding the visual axis, compressing the globe, or expanding into the retrobulbar space. The diagnosis is usually established clinically, but imaging studies should be considered if there is a concern regarding other orbital soft tissue tumors (rhabdomyosarcoma, neuroblastoma, plexiform neurofibroma, or lymphatic malformation) and to assess the full extent of the tumor.3 During the growth phase of periocular hemangiomas, patients warrant close evaluation and follow-up by a multidisciplinary team comprising an ophthalmologist, dermatologist/pediatrician, and ideally a plastic surgeon. Systemic corticosteroids are the treatment of choice for hemangiomas that cause visual compromise. Other treatment options include intralesional or topical corticosteroids, interferon-α, and surgery, but their use may be limited by potential risks or lack of efficacy.3 The vascular nature of these lesions poses the challenge of potentially significant hemorrhage and surgical intervention is therefore often avoided. However, as we report herein in a child with a sight-threatening periocular hemangioma who failed to respond to oral corticosteroids, surgical debulking can be a valuable treatment option to save vision with an excellent cosmetic result.