Orbital Complications of Acute Rhinosinusitis in Adulthood: Predictors of Outcome and Management

ABSTRACT Objectives Orbital infections of acute rhinosinusitis are commonly classified thanks to the Chandler classification and may lead to vision loss or diplopia if not properly managed. While pediatric cases are well documented and their management is supported by clear evidence, data guiding adult management remain limited and fragmented. This study analyzes a large international cohort of patients that evaluates treatment approaches and outcome predictors for orbital complications ( OCs ) of acute sinusitis in adulthood. Methods This multicentric retrospective study included adults with OCs of acute sinonasal infections. Patients were classified using the Chandler classification, with an additional subdivision for pre‐septal infections (modified Chandler classification). Clinical, radiologic, and therapeutic data were analyzed, evaluating treatment success, hospital stay, and complications. Predictors of treatment and outcomes were studied ( p < 0.05). Results Among 213 patients (65.3% male, median age 48), 68.2% required surgery, mainly endoscopic (60.7%). Logistic regression identified the presence of additional complications ( p = 0.015) and modified Chandler classification ( p < 0.001) as the strongest predictors for treatment modality, while sinus opacification and visual impairment lost significance in the multivariate model. Infection resolution after primary treatment was significantly associated with nasal corticosteroid use ( p = 0.037). Despite differences in treatment approach and hospitalization duration across modified Chandler categories, no significant differences were observed in final ophthalmologic outcomes. Conclusion This study emphasizes the role of the modified Chandler classification for upfront treatment decisions. Abscess‐related and type II OCs often needed surgery, yet all cases achieved similarly optimal ophthalmologic outcomes and final infectious resolution. Level of Evidence 4.

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Publication Details

Journal
The Laryngoscope
Published
2025-12-12
DOI
https://doi.org/10.1002/lary.70309
Primary Topic
Sinusitis and nasal conditions
Type
article
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article

Orbital Complications of Acute Rhinosinusitis in Adulthood: Predictors of Outcome and Management

Marco Valentini, Christos Georgalas, Apostolos Karligkiotis, Cesare Piazza et al.
The Laryngoscope
Sinusitis and nasal conditions
article

Orbital Complications of Acute Rhinosinusitis in Adulthood: Predictors of Outcome and Management

Marco Valentini, Christos Georgalas, Apostolos Karligkiotis, Cesare Piazza, Andrea Ronchi, Mario Turri–Zanoni, Matteo Barucco, Piero Nicolai, Kays Burak Çakır, Marco Ferrari, Umberto Tanzini, Yaşar Ünlü, Alberto Daniele Arosio, Paolo Castelnuovo, Alessandro Vinciguerra, Alberto Schreiber, Yetkin Zeki Yılmaz, Mario Bussi, Giulia Danè, F Bernardi, Iacopo Dallan, Stefano Taboni, Piergiorgio Gaudioso, Davide Mattavelli, Giuseppe Mercante, Fabio Sovardi, Vittorio Rampinelli, Benjamin Vérillaud, Jessica Zuppardo, Florian Chatelet, Antonio Daloiso, L. Girolami, Vasileios Chatzinakis, Fabio Pagella, Alperen Vural, Paolo Battaglia, Nicola Tessari, Federico Raimondi, Philippe Herman, Maurizio Bignami, Argyro Leventi
article en

Abstract

ABSTRACT Objectives Orbital infections of acute rhinosinusitis are commonly classified thanks to the Chandler classification and may lead to vision loss or diplopia if not properly managed. While pediatric cases are well documented and their management is supported by clear evidence, data guiding adult management remain limited and fragmented. This study analyzes a large international cohort of patients that evaluates treatment approaches and outcome predictors for orbital complications ( OCs ) of acute sinusitis in adulthood. Methods This multicentric retrospective study included adults with OCs of acute sinonasal infections. Patients were classified using the Chandler classification, with an additional subdivision for pre‐septal infections (modified Chandler classification). Clinical, radiologic, and therapeutic data were analyzed, evaluating treatment success, hospital stay, and complications. Predictors of treatment and outcomes were studied ( p < 0.05). Results Among 213 patients (65.3% male, median age 48), 68.2% required surgery, mainly endoscopic (60.7%). Logistic regression identified the presence of additional complications ( p = 0.015) and modified Chandler classification ( p < 0.001) as the strongest predictors for treatment modality, while sinus opacification and visual impairment lost significance in the multivariate model. Infection resolution after primary treatment was significantly associated with nasal corticosteroid use ( p = 0.037). Despite differences in treatment approach and hospitalization duration across modified Chandler categories, no significant differences were observed in final ophthalmologic outcomes. Conclusion This study emphasizes the role of the modified Chandler classification for upfront treatment decisions. Abscess‐related and type II OCs often needed surgery, yet all cases achieved similarly optimal ophthalmologic outcomes and final infectious resolution. Level of Evidence 4.

The Laryngoscope
University of Insubria (IT), Humanitas University (IT), University of Padua (IT), Vita-Salute San Raffaele University (IT), University of Nicosia (CY), Université Paris Cité (FR), Ospedale Papa Giovanni XXIII (IT), Istanbul University-Cerrahpaşa (TR), Hôpital Lariboisière (FR), Azienda Socio Sanitaria Territoriale Lariana (IT), Policlinico San Matteo Fondazione (IT), IRCCS Humanitas Research Hospital (IT), Azienda Ospedaliera Universitaria Pisana (IT), University of Brescia (IT), Erciyes University (TR)
Openalex Percentile: Top 44%
Sinusitis and nasal conditions
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