As the infection tracts posteriorly, patients complain of orbital pain and fullness accompanied by periorbital edema and visual disturbances. In some patients, periorbital findings do not develop early on, and the clinical picture is subtle. Without effective therapy, signs appear in the contralateral eye by spreading through the communicating veins to the contralateral cavernous sinus. Death follows shortly thereafter. Chemosis Eyelid edema Periorbital edema Manifestations of increased retrobulbar pressure follow.
Pupillary responses are sluggish.
Decreased visual acuity is common owing to increased IOP and traction on the optic nerve and central retinal artery. Cranial nerve palsies are found regularly. Isolated sixth nerve dysfunction may be noted before obvious orbital findings. Extraocular movements may be impaired. Depressed corneal reflex is possible.