Disclaimer: The information contained within the Grand Rounds Archive is intended for use by doctors and other health care professionals. These documents were prepared by resident physicians for presentation and discussion at a conference held at Baylor College of Medicine in Houston, Texas. No guarantees are made with respect to accuracy or timeliness of this material. This material should not be used as a basis for treatment decisions, and is not a substitute for professional consultation and/or peer-reviewed medical literature.

Orbital Complications of Sinusitis
Carrie Roller, M.D.
November 12, 1998

Case Presentation:

S.G is an 11-year-old boy who presented with a chief complaint of 2 days of swelling of the right eye. Two weeks prior to admission he began to have nasal congestion, which progressed to purulent rhinorrhea with headache and fever. Two days prior to admission he began to note edema and erythema of the right eye. He denied any vision changes including diplopia, nor had he had any difficulties with his left eye. His mother denied any history of medical problems or surgery, and his immunizations were up to date. He had not experienced any trauma or had any dental complaints or procedures recently.

On Physical Examination, he had a temperature of 101.3 F, purulent nasal discharge, erythema and edema of both his upper and lower eyelids on the right, proptosis, conjunctival injection and limited extraocular movements. His vision was grossly intact. He had no abnormalities of the left eye. Neurologic exam was normal except for the above-noted decrement in extraocular motion of the right eye. Physical exam was otherwise normal for an 11 year old boy.

Ophthalmologic consultation was obtained to follow S.G.'s visual status and fundoscopic examination (normal on admission). The patient was started on broad-spectrum intravenous antibiotics as well as nasal saline and neosynephrine nasal spray. CT of the sinuses and orbits was ordered. CT revealed pansinusitis with medial subperiosteal enhancement in the right orbit. After 24 hours of IV antibiotics there was no improvement on physical exam, and the patient's vision was noted to decrease from 20/20 to 20/40 on the right. Urgent ethmoidectomy was performed in the operating room, with drainage of pus from the subperiosteal abscess in the medial aspect of the right eye. Postoperatively the patient remained on IV antibiotics and was discharged in good condition 1 week after surgery.

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