What are the orbital complications of acute sinusitis?

Updated: Apr 22, 2020
  • Author: Ted L Tewfik, MD; Chief Editor: Arlen D Meyers, MD, MBA  more...
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Orbital complications are the most common complications encountered with acute bacterial sinusitis. Infection can spread directly through the thin bone separating the ethmoid or frontal sinuses from the orbit or by thrombophlebitis of the ethmoid veins. Diagnosis should be based on an accurate physical examination including ophthalmological evaluation and appropriate radiological studies. CT scanning is the most sensitive means of diagnosing an orbital abscess, although ultrasound has been found to be 90% effective for diagnosing anterior abscesses. [21] The classification by Chandler, which is based on physical examination findings, provides a reasonable framework to guide management. This classification consists of 5 groups of orbital inflammation [22] :

  • Group 1 - Inflammatory edema (preseptal cellulitis) with normal visual acuity and extraocular movement

  • Group 2 - Orbital cellulitis with diffuse orbital edema but no discrete abscess

  • Group 3 - Subperiosteal abscess beneath the periosteum of the lamina papyracea resulting in downward and lateral globe displacement

  • Group 4 - Orbital abscess with chemosis, ophthalmoplegia, and decreased visual acuity

  • Group 5 - Cavernous sinus thrombosis with rapidly progressive bilateral chemosis, ophthalmoplegia, retinal engorgement, and loss of visual acuity; possible meningeal signs and high fever

A retrospective study by Cushen and Francis found that the occurrence of orbital cellulitis in association with the acute sinusitis is rare. The investigators reported the incidence to be 1.50 per 10,000 acute sinusitis episodes. Moreover, antibiotic administration in acute sinusitis was not linked to a significant change in the incidence of orbital cellulitis. [23]  

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