PURPOSE: To assess the effects of systemic propranolol on refractive error in infants with periocular capillary hemangiomas. METHODS: A single-center study of consecutive patients with capillary hemangiomas treated with systemic propranolol. Refractive data were analyzed using Long's matrix formalism and the methods of Harris and Kaye. RESULTS: Seventeen patients were included. At 6 months postoperatively, hemangioma size reduced from 3,214 to 1,806 mm(3) (standard deviation: 4,122 to 2,441). Mean refractive error in the affected eye significantly reduced: -1.25/0.38 x 36 (95% confidence intervals: -5.08/1.20 x 90 to 1.64/1.43 x 180, P = .048) with a smaller change (P = .06) in the unaffected eye of -1.01/+0.31 x 3.16 (95% confidence intervals: -4.02/+1.12 x 180 to +1.49/+0.51 x 90). CONCLUSIONS: Propranolol produced a clinically significant reduction in the infants' refractive error and anisometropia. The reduction in the total refractive error and anisometropia has not been evident in previous analyses, which have concentrated on the change in the "cylinder" as the principal outcome measure.