Complications of sinusitis

Patients with untreated sinus infections are at risk of severe complications, which may be the presenting sign. Complications may result from the eye or brain involvement directly or indirectly from the affected sinus. Sinusitis at the forehead region (frontal ) and back of the eye (sphenoid) are the most likely to lead to intracranial complications. In addition, headache is a notable manifest in these patients. The rate of complications of sinusitis is estimated to occur in around 5% of patients hospitalized for acute sinusitis.

Findings that suggest the possible intracranial extension include:

  • The combination of swelling around the eyes (periorbital) with persistent headache and vomiting;

  • Vomiting and headache that necessitates hospital admittance;

  • Vomiting that continues for longer than 24 hours;

  • Reduce in the level of consciousness or behavior;

  • Impairments of nerve & brain function that affect a particular body region, e.g., weakness in the left arm, leg, speech disorder, etc., are seen in stroke patients. 

  • Neck stiffness (infection of the covering membranes of the brain & spinal cord).

Clinical signs distinct to eye and brain complications of sinusitis are listed below:

  • Swelling & inflammation around the eye – complication identified by swelling of the eyelids and surrounding eye. No weakness of eye movement.

  • Inflammation within the eye cavity – swelling, redness of the eyelid, painful eye movement, a bulge on the surface cover of the eyeball, protrusion of the eyeball, limited eye movement, double vision, or even blindness.

  • Pus formation within the cavity of the eyeball – swelling around the eye, painful eye movement, protrusion of the eyeball, double vision, blindness; Eye imaging scan is crucial to establish the diagnosis.

  • Blood clot formation blocks a vein that runs through a hollow space beneath the brain and behind the eye sockets– Bilateral eye protrusion, restricted eyeball movement, eye swelling, severe headache, and altered consciousness.

  • Infection of the brain covering – Fever, headache, neck rigidity, and altered mental status.

  • Infection of the forehead bone associated with forehead or scalp swelling (Pott puffy tumor), pain, headache, light sensitivity or eye discomfort to light exposure, fever & vomiting.

  • Brain abscess – Fever, severe headache, neck stiffness, progressive abnormal body function due to insult to the brain and nerves, fits and elevated pressure within the skull.