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Infectious sinusitis complications continue to be a frequent occurrence. These complications mostly occur in the orbital cavity or in the intracranial space. Most clinical reports indicate that, despite the near universal implementation of antipneumococcic conjugates vaccination, the incidence of these has been stable. The goals of this chapter will be to review the clinical manifestations of these infections, summarize the literature on best treatment practices, consider the effect of pneumococcal vaccines, describe changes in published bacterial pathogen profiles, and articulate expected outcomes of patients with these complicated infections.

Throughout the history of medicine, orbital cellulitis has been and continues to remain a serious infection that can lead to significant vision and life-threatening sequelae. Just over a century ago, patients and physicians diagnosed and managed orbital cellulitis prior to the discovery of antibiotics, radiographic imaging, or anesthesia for surgery. While modern medicine has the benefit of advanced imaging techniques, potent antibiotics, and refined surgical approaches, it is useful to remember and appreciate the historical aspects of orbital cellulitis and its management.

Orbital cellulitis is a serious infectious condition that can lead to orbital abscess formation, optic neuropathy, meningitis, intracranial abscess, or even death. Given these potential vision and life-threatening consequences, successful management depends on the prompt and accurate clinical diagnosis to implement the appropriate medical and surgical treatments. This chapter provides an overview of the various etiologies of orbital cellulitis and their patterns of presentation, the crucial clinical findings on ophthalmic and orbital evaluation, and indications for surgical intervention.

Orbital cellulitis is an acute infectious inflammation of the post-septal orbital tissues that can be complicated by the development of a subperiosteal abscess. Prompt evaluation and urgent management are often critical to preventing vision and life-threatening sequelae. Specific clinical and radiographic criteria can be useful in the decision to undergo surgery. Depending on the size and location of the abscess, a variety of surgical approaches to the orbit are available. With proper diagnosis, good antibiotic therapy, and prompt surgical abscess evacuation when indicated, patients with orbital abscesses have an excellent prognosis.

Nonsurgical medical therapies are currently the mainstay for managing most cases of orbital cellulitis, with or without abscess. With improved understanding of the underlying etiologies and microbiology that cause orbital cellulitis, prompt and aggressive local and systemic treatments, antibiotics, and corticosteroids allow many patients to be successfully treated without undergoing the risks or sequelae of surgical intervention. While certain patients still require surgical intervention, medical therapies remain the first-line treatment in most cases of bacterial and fungal orbital cellulitis.