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

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.