Orbital Complications of Rhinosinusitis in Adults: A 10-Year Retrospective Cohort Study

TL;DR

This study examines rare but serious eye-related complications from sinus infections in adults, finding that age and disease stage influence treatment needs and outcomes.

Contribution

The study provides a detailed 10-year analysis of clinical features and treatment outcomes for adult orbital complications of rhinosinusitis.

Findings

Most patients were male with a mean age of 44.3 years, and acute rhinosinusitis was more common than chronic.

Advanced disease stages were associated with older age, but prior sinus surgery or antibiotic use did not worsen outcomes.

Over half of patients improved with intravenous antibiotics alone, while the rest required surgery and fully recovered.

Abstract

Background

Orbital complications of rhinosinusitis are rare in adults but may result in serious outcomes such as vision loss or intracranial involvement. While more frequently reported in children, adult cases tend to present with greater severity. Early recognition and appropriate management are essential. This study aims to describe the clinical characteristics, diagnostic methods, treatment strategies, and outcomes of adult patients with orbital complications secondary to acute or chronic rhinosinusitis.

Methodology

A retrospective cohort study was conducted among 28 adults admitted to a tertiary hospital between 2012 and 2022 with CT-confirmed orbital complications of rhinosinusitis. Data included demographics, comorbidities, Chandler stage, prior sinus surgery, treatments, and outcomes.

Results

Most patients were male (60.7%), with a mean age of 44.3 years. Acute rhinosinusitis (67.9%) was more common than chronic (32.1%). Patients with advanced Chandler stages III-IV were significantly older (mean age = 62 vs. 35 years; p = 0.002). Comorbidities and previous outpatient antibiotic use showed no association with severity. Among chronic rhinosinusitis cases, 55.5% had a history of endoscopic sinus surgery; however, this was not associated with worse outcomes. Over half of the patients (53.4%) were treated successfully with intravenous antibiotics alone, while 46.4% required surgical intervention. No patients developed cavernous sinus thrombosis, and all achieved full recovery without long-term sequelae.

Conclusions

Orbital complications of rhinosinusitis in adults are uncommon but clinically significant. Age is a key predictor of severity. Early-stage cases can often be managed conservatively, while advanced cases require surgery. Early imaging and multidisciplinary care are critical for optimal outcomes.

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