Orbital involvement in acute sinusitis. Lessons from 24 childhood patients.

The possibility of acute bacterial sinusitis should be considered in any child with sudden swelling about the orbit. Management is determined by the stage of the disease as well as by the sinus predominantly involved. Extraocular movements and proptosis are the best guidelines for therapy. When there is no proptosis and extraocular mobility is normal, conservative therapy with intravenous antibiotics and nasal decongestants is usually effective. When ocular mobility is impaired or proptosis develops, intranasal or external surgical drainage are usually required. Of 24 patients summarized in this paper, the ethmoid was the predominantly involved sinus in 12, the frontal in 7, the maxillary in 5. Only 4 of the 12 with predominant ethmoiditis required surgery. All 7 were predominant frontal involvement needed surgical drainage.