The organisms involved are those responsible for the underlying sinusitis, although S. aureus is more common in osteomyelitis than in sinusitis. Treatment should include decongestants for the sinusitis, high-dose intravenous antibiotics for the osteomyelitis, and surgical debridement when bone destruction is substantial. It is important to rule out coexisting brain abscess of the frontal lobe, which may be clinically occult. Because the orbit is bordered on three sides by the paranasal sinuses, orbital infection can result from sinusitis. Orbital cellulitis usually begins with edema of the eyelids and rapidly progresses to ptosis, proptosis, chemosis, and diminished extraocular movements.
Patients are usually febrile and acutely ill.
Therapy with high-dose intravenous antibiotics is mandatory. Unless a specific pathogen can be isolated from the blood or from purulent drainage, antibiotics should cover both staphylococci and gram-negative rods. Retrograde spread along venous channels from the sinuses, the orbit, or the nose can produce septic cavernous sinus thrombophlebitis. Patients have high fever and appear toxic. Lid edema, proptosis, and chemosis are present.