Orbital complications of sinusitis

Despite the modern antibiotherapies applied in the practice of otorhinolaryngology, the orbital complications of sinusitis are still considered a serious threat to essential functions of the eye, including loss of vision, and at worst, life threatening symptoms.

The goal of this study is to consider and analyse patients who were treated for these complications in the last decade in our hospital, which is the only tertiary hospital in our country.

Retrospective analysis of cases.

In our practice, cases treated in the hospital are rhinosinusitis cases where surgical intervention is necessary, or those with a suspicion of complications. Between the years 1999 and 2009 there were 177 cases, the clinical charts of which were reviewed. The cases that are omitted from this study are those involving soft tissues, bone, and intracranial complications. The diagnoses were determined based on anamnesis, anterior rhinoscopy, x-rays of the sinuses with the Water's projection or where there was a suspicion of a complication, and CT scans with coronal and axial projections. In all cases, intensive treatment was initiated with a combination of cefalosporines, aminoglycosides and Proetz manoeuvre. When an improvement in the conditions did not occur within 24-48 hours, we intervened with a surgical procedure, preferably the Lynch-Patterson external frontoethmoidectomy.

In our study, we encountered 35 cases (19.8%) of orbital complications with an average age of 25 (range: 3-75); Palpebral inflammatory oedema (15), orbital cellulitis (10), subperiosteal abscess (6), orbital abscess (3), and cavernous sinus thrombosis (1 patient). The average time that patients remained in hospital was 4.6 days; for those with orbital complications this was 7 days.

Orbital complications of sinusitis are considered to be severe pathologies. The appearance of oedema in the corner of the eye should be evaluated immediately and the means to exclude acute sinusitis should be taken under serious consideration. Early diagnosis and aggressive treatment are key to the reduction of these unwanted manifestations.