Management of orbital complications of acute rhinosinusitis: A 13-year experience.

Introduction: After the development of antibiotics and early diagnostic methods, the complications of acute rhinosinusitis (ARS) have reduced in recent years. However, in clinical practice, we still observe both orbital and intracranial complications. The aim of this study is to describe a series of patients with complications of ARS and to define what clinical and radiological characteristics may indicate the need of surgical treatment.

Materials: Retrospective observational study of patients diagnosed with orbital complications secondary to ARS who were hospitalized at a tertiary hospital between 2010 and 2023. Demographic, clinical, radiological, microbiological data, therapeutic strategy and hospitalization time were studied.

Results: Fifty-six patients were included (59% male), with a mean age of 11.5 years (37 under 18 years old). The most frequent symptoms were eyelid edema (98%) and erythema (89%), proptosis (46%) and fever (50%). According to Chandler's classification, the most frequent complications were subperiosteal abscesses (46%) and orbital cellulitis (23%). There were six cases of orbital abscesses and one cavernous sinus thrombosis. The most frequently used antibiotic was amoxicillin + clavulanic acid (54%). Surgical intervention was necessary in 26 patients (46%).

Conclusion: Orbital complications of ARS are rare, but they can have potentially vision-threatening and life-threatening complications. Therefore, it is essential to consider them in the differential diagnosis, and in case of suspicion, initiate antibiotic treatment as soon as possible, with or without surgical drainage. Endoscopic surgery is the preferred approach, but it may be necessary to combine it with external drainage, especially in lateral locations or on the orbital roof.