Pediatric patients with acute rhinosinusitis may suffer severe, occult-onset orbital and cranial complications. Endoscopic intervention is beneficial for people having vision impairment, a lack of response to conservative therapy, and any signs of intracranial complications.

The purpose of the study was to evaluate the clinical features, depict the diagnosis, and therapeutic experience of pediatric acute rhinosinusitis orbital and cranial complications.

The clinical information of 24 children who underwent endoscopic sinus surgery along with medication therapy for cranial and orbital complications of acute rhinosinusitis was retrospectively evaluated. There were 5 girls and 19 boys. The median age was 47.5 months, ranging from 13 to 159 months.

Twelve solitary subperiosteal orbital abscesses, two linked with preseptal abscesses, two related to intraorbital abscesses, seven related to optic neuritis, and one linked with septic cavernous sinus thrombosis were diagnosed. Clinical traits, isolated organisms, and results were examined using descriptive approaches.

All 24 people presented with fever; nine presented with purulent discharge and nasal congestion. All patients had orbital edema, pain, proptosis, and globe displacement as clinical signs of orbital infection, and seven children had vision impairment. Notably, 17 patients had purulent discharge cultured, and 12 of them had positive results.

Except for one patient who needed a second surgery, all patients received nasal endoscopic surgical operations uneventfully. The follow-up time span was 5 to 64 months. With the exception of two children who developed preoperative irreversible blindness with visual loss, all patients recovered totally. Neither death nor recurrence occurred.

Pediatric acute rhinosinusitis may cause severe, occult-onset orbital and cranial sequelae. Immediate endoscopic intervention is required for individuals who have vision impairment, any indications of intracranial problems, and a failure to respond to conservative therapy.