How are orbital complications of acute bacterial sinusitis (sinus infection) diagnosed and classified?

Updated: Mar 01, 2018
  • Author: Itzhak Brook, MD, MSc; Chief Editor: Michael Stuart Bronze, MD  more...
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Diagnosis should be based on an accurate physical examination, including ophthalmological evaluation and appropriate radiological studies. CT scanning is the most sensitive means of diagnosing an orbital abscess, although ultrasound has been found to be 90% effective for diagnosing anterior abscesses. [28] The classification by Chandler, which is based on physical examination findings, provides a reasonable framework to guide management. This classification consists of 5 groups of orbital inflammation [32] :

  • Group 1 - Inflammatory edema (preseptal cellulitis) with normal visual acuity and extraocular movement

  • Group 2 - Orbital cellulitis with diffuse orbital edema but no discrete abscess

  • Group 3 - Subperiosteal abscess beneath the periosteum of the lamina papyracea resulting in downward and lateral globe displacement

  • Group 4 - Orbital abscess with chemosis, ophthalmoplegia, and decreased visual acuity

  • Group 5 - Cavernous sinus thrombosis with rapidly progressive bilateral chemosis, ophthalmoplegia, retinal engorgement, and loss of visual acuity; possible meningeal signs and high fever

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