Complications of acute bacterial rhinosinusitis in children

Complications involving the orbit	Clinical manifestations
Preseptal complications
Preseptal cellulitis	Swelling of eyelids/periorbital area Erythema of eyelids/periorbital area Absence of proptosis Normal eye movements
Postseptal complications
Orbital cellulitis* Orbital subperiosteal abscess* Orbital abscess*	Periorbital swelling Erythema of eyelids Pain with eye movement Conjunctival swelling (chemosis) Proptosis Limitation of eye movements Double vision Vision loss
Intracranial complications	Clinical manifestations
Septic cavernous sinus thrombosis	Ptosis Proptosis Limitation of eye movements Bilateral periorbital edema Headache Change in mental status
Meningitis	Fever Headache Nuchal rigidity Change in mental status
Osteomyelitis of the frontal bone with subperiosteal abscess (Pott puffy tumor)	Fever Forehead or scalp swelling and tenderness Headache Photophobia Vomiting Lethargy
Epidural abscess^¶	Focal neurologic signs Headache Lethargy Nausea Vomiting Papilledema
Subdural abscess^¶	Fever Severe headache Meningeal irritation Progressive neurologic deficits Seizures Vomiting Papilledema
Brain abscess^¶	Headache Neck stiffness Change in mental status Vomiting Focal neurologic deficits Papilledema Third and sixth cranial nerve deficits

* Imaging is necessary to distinguish between orbital cellulitis, orbital subperiosteal abscess, and orbital abscess.

¶ Imaging is necessary to distinguish between epidural abscess, subdural abscess, and brain abscess.

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