Naevus flammeus is a benign cutaneous angioma which often appears on the face causing cosmetic concern. Earlier this century, radiotherapy was frequently employed to try to remove the lesion. Thorium X, an alcohol-based paint was a favoured radiotherapeutic agent. Unfortunately, thorium X therapy has side effects including carcinogenesis. The case of a 62-year-old lady who suffered gross neoplastic dermal disease as well as the full gamut of ophthalmic radiation related disease after thorium X radiotherapy for naevus flammeus, is presented. The management of this patient included extensive plastic surgery and prosthetic contact lens fitting.

Discussion The history of radiotherapy for naevus flammeus and other angiomata leaves a striking message about the risks of long-term sequelae of new treatments. Current treatment for naevus flammeus is also controversial. This case demonstrates the ocular and dermal sequelae of radiation injury and how it can be managed. The process of prosthetic contact lens fitting is considered in detail. The outcome of this process is a dramatic improvement in the patient’s self-confidence and quality of life.

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