Orbital Complications of Acute Sinusitis in Pediatrics: A Narrative Review

Abstract

Background: Orbital complications of acute pediatric rhinosinusitis, such as subperiosteal and orbital abscess, meningitis, and intracranial extension, represent time-sensitive conditions requiring prompt diagnosis and management. Improved understanding of the anatomic, microbiologic, and clinical factors contributing to these complications is essential for optimizing outcomes. Methods: This review synthesizes current literature on the diagnosis and management of orbital complications in pediatric acute sinusitis, with emphasis on risk stratification, imaging indications, and surgical decision-making. Two representative case studies are included to illustrate diagnostic and therapeutic considerations. Results: While pediatric patients may improve with medical therapy alone, abscess formation or progressive complications despite antibiotics often necessitate surgical intervention. Clinical presentation, ophthalmologic examination findings, and abscess characteristics are critical in risk stratification and determinants for surgical management. Conclusion: A high likelihood of suspicion of an underlying sinus disease is warranted when evaluating children with periorbital redness and swelling. Monitoring and further evaluation with imaging are critical to prevent acute rhinosinusitis with orbital complications and vision-threatening sequelae.