Spread of Sinus Infection to the Eyes

Introduction

One of the most usual complications of sinusitis is an infection of the eyes which accounts for about 85 % of the cases. The ethmoid sinus is most commonly affected by sinusitis than the frontal and maxillary sinuses. The infection spreads through the blood vessels of the sinuses to the orbit. A sinus infection usually resolves in less than a month with appropriate treatment. Some patients may experience a relapse or long-standing (chronic) sinus infections.

What Is Sinusitis?

Sinuses are hollow spaces present near the eyes and nose. The sinuses produce mucus that drains through the nose. Sinuses are filled with air but can be filled with fluid in case of any blockage. Accumulation of extra fluid in the sinuses makes it favorable for bacteria, viruses, and fungi to grow which triggers an infection.

What Are the Different Types of Sinuses?

The following are the different types of sinuses:

• Maxillary Sinuses: Present below the eyes.

• Ethmoidal Sinuses: Present between the eyes.

• Sphenoidal Sinuses: Located behind the eyes.

• Frontal Sinuses: Located above the eyes.

What Are the Symptoms of Sinusitis?

The symptoms of sinusitis are as follows:

• Runny or congested nose.

• Headache.

• Pain in the face.

• Postnasal drip.

• Cough.

• Fever.

• Sore throat.

• Sinus pressure.

• Bad breath.

What Are the Symptoms in the Eyes That Are Linked to Sinusitis?

The symptoms in the eyes include:

• Sinus Pressure and Eye Pain: With a sinus infection, one can experience pain behind the eyes or around the eyes. This might resemble a pain in the eyes or a headache behind the eyes.

• Sinus Pressure and Watery Eyes: A long-standing (chronic) sinus infection can result in watery eyes which is called epiphora. Watery eyes can also occur with colds or allergies accompanied by a feeling of congestion and pressure. A cluster headache could also cause watery eyes, sinus pressure, and a stuffy nose.

• Sinus Pressure and Swollen Eyes: A sinus infection could lead to swelling of eyelids and puffiness of the eyes. This can be a result of inflammation and accumulation of mucus in the sinuses between and below the eyes. The swelling subsides with treatment.

Other symptoms include redness, itchy eyes, bulging eyes, double vision, and impaired eye movement.

What Are the Eye Infections That Occur as a Result of Sinusitis?

The following are the eye infections that occur due to sinusitis:

1. Periorbital Cellulitis: It is also called preseptal cellulitis. The area surrounding the eyes including the eyelid becomes infected in this condition. A fibrous tissue surrounding the eyeball acts as a barrier and prevents periorbital cellulitis from developing into orbital cellulitis. Fever can occur occasionally with periorbital cellulitis. Vision or eye movement is not affected in periorbital cellulitis.

2. Orbital Cellulitis: An infection involving the soft tissues within the eye socket is called orbital cellulitis. It is an emergency condition that when left untreated can result in life-threatening complications and permanent loss of vision. It is also called post-septal cellulitis.

Symptoms: Symptoms of orbital cellulitis include:

• A red, swollen eyelid.

• Impaired eye movement or pain with movement.

• Impaired vision or sudden loss of vision.

• Difficulty or inability to open the eye.

• Discharge from the infected eye.

• Proptosis (forward displacement or protrusion of the eye).

• Fatigue.

• Fever.

• Loss of appetite.

• A headache.

Causative Organisms: Staphylococcus aureus and Streptococci species are responsible for causing orbital cellulitis. About 86 to 98 percent of the people suffering from orbital cellulitis have sinusitis.

Diagnosis: If one experiences symptoms of orbital cellulitis, it is advisable to seek medical consultation as early as possible since early treatment can prevent severe complications. A few diagnostic methods include:

• A complete physical examination checking for redness, swelling, fever, and pain will be conducted by an ophthalmologist (expert in treating the diseases of the eyes).

• A sample of the individual’s blood or discharge from the eye may be obtained to analyze which microorganism is causing the infection.

• An MRI (magnetic resonance imaging) or CT (computed tomography) scan may be suggested to study the extent of the infection and to determine the complications that affect the brain or central nervous system.

Treatment: Two standard treatment options include:

• Antibiotics: The first line of treatment following diagnosis of orbital cellulitis is treated with antibiotics. Antibiotics are administered through an intravenous (through veins) route. Broad-spectrum antibiotics are preferred by healthcare professionals in treating orbital cellulitis since they act against a wide range of bacteria. Since this infection can spread quickly to other body parts, it is necessary to monitor the patient closely to check if the infection has worsened or if the response to antibiotics has improved or deteriorated.

• Surgery: Surgery is preferred if the infection spreads to other regions of the head or if there is no response to antibiotics. Other reasons to opt for surgery include the development of an abscess in the eye socket or the brain, a foreign object entrapped in the eye, the development of a fungal or mycobacterial infection, or experiencing symptoms that have worsened or if there is a vision impairment following the intake of antibiotics. Surgical procedures include draining fluid from the infected area or abscess, removal of the foreign object, and obtaining a culture sample for laboratory analysis.

Complications: A few complications of orbital cellulitis include:

• Vision loss.

• Hearing loss.

• Meningitis (inflammation of the membranes that line the brain and the spinal cord).

• Cavernous sinus thrombosis (formation of blood clots at the base of the brain).

• An intracranial abscess (deposition of pus inside the skull).

Symptoms can be severe in young children since their immune system is still immature. Red, swollen, and painful eyelids can occur in both periorbital and orbital cellulitis. Fever is more common in orbital cellulitis than in periorbital cellulitis.

1. Cavernous Sinus Thrombosis: This is a less common but serious complication of sinusitis. Symptoms usually start in one eye and spread to the other eye. Since many important arteries and nerves related to the eyes pass through the cavernous sinus, infection in this region can result in severe eye complications. Immediate medical intervention is mandatory since infection in the cavernous sinus can cause blindness in 15 % of individuals.

Symptoms: Symptoms include:

• Swelling of the eyelids.

• Pain around the eyes.

• Ptosis (drooping eyelids).

• Diplopia (double vision).

• Photophobia (sensitivity to light).

• Loss of vision.

Rare symptoms include confusion, a stiff neck, numbness in the face, and coma. Cavernous sinus thrombosis is treated with antibiotics, antifungal medications, and medications to prevent the formation of blood clots.

What Are the Other Complications if Sinusitis Is Left Untreated?

Other complications are as follows:

• Difficulty in breathing.

• Reduced or complete loss of smell.

• Laryngitis (inflammation of the voice box or larynx).

• Dacryocystitis (infection or inflammation of the tear sac caused due to blockage in the tear duct).

• Meningitis (inflammation of the protective covering surrounding the brain and spinal cord called the meninges).

• A subdural abscess (collection of pus in the space between the outer and middle layers of the meninges which is called the subdural space).

• Frontal bone osteomyelitis (a complication of sinus infection involving the frontal sinuses situated in the frontal bone above the eyebrows).

• Brain abscess (collection of pus within the brain substance due to the spread of infection from the paranasal sinuses).

When Should One Consult a Doctor?

One should consult a doctor when there are:

• Stiffness of the neck.

• High fever.

• Difficulty in breathing.

• Confusion.

• Blurred vision or other vision changes.

• Swelling in the eyes and feeling of pressure in the eyes.

• Swelling around one or both eyes.

• Severe pain inside and outside the eyes.

Conclusion

The majority of people gain recovery within a week from sinusitis without the need for antibiotics but can recover more quickly if antibiotics are taken as prescribed by the physician. If sinusitis persists for more than a week and if it is not treated, it can result in severe complications. One such complication is the sinus infection spreading to the eye which needs to be treated with intravenous antibiotics. Another rare complication of untreated sinus infection is the extension of the infection to the brain resulting in brain abscess or meningitis both of which could pose a threat to life.