Synopsis
Detect spread of sinus infection beyond the nasal cavity, protect vision and neurological function, and coordinate urgent imaging, antimicrobials and source control.
- Eyelid inflammation anterior to the orbital septum differs from infection within the orbit, but early clinical findings can overlap.
- Record vision, pupils, colour perception and eye movements where possible; inability to examine is itself an escalation concern.
- A normal initial visual acuity does not exclude evolving orbital infection or a collection.
Key red flags
Reduced acuity or colour vision, an afferent pupillary defect, diplopia or painful restricted eye movements with sinus infection requires immediate ophthalmic and ENT assessment.
Investigation priorities
Identify threatened function and provide a comparison for repeated assessment.
Management branches
Sinus symptoms are accompanied by orbital signs or possible neurological involvement.
- Assess airway, breathing, circulation and consciousness, and arrange emergency transfer appropriate to clinical stability.
- Communicate eye findings, neurological changes, symptom trajectory, immune status, allergies and antibiotics already received.
Key medicines
Ceftriaxone plus metronidazole: an adult orbital cellulitis exampleThe Oxford University Hospitals adult orbital cellulitis pathway uses ceftriaxone 2 g intravenously once daily plus metronidazole 400 mg orally three times daily. Its stated treatment course is seven to fourteen days, with intravenous treatment reviewed daily.