Emerg Med J doi:10.1136/emermed-2013-202656
  • Images in emergency medicine

Sudden onset proptosis: a rare presentation of sinusitis

  1. Fergal Cummins2,3
  1. 1Graduate Entry Medical School, University of Limerick, Limerick, Ireland
  2. 2Emergency Department, University Hospital Limerick, Limerick, Ireland
  3. 3Retrieval, Emergency and Disaster Medicine Research and Development Unit (REDSPoT), University Hospital Limerick, Limerick, Ireland
  1. Correspondence to Dr Rosa McNamara, Graduate Entry Medical School, University of Limerick, Limerick, Ireland; rosa.mcnamara{at}
  • Accepted 1 April 2013
  • Published Online First 1 May 2013

Case report

A 45-year-old male presented to the emergency department with sudden onset left-sided orbital swelling, ecchymosis and decrease in vision.

Examination revealed left-sided proptosis, a well demarcated blue swelling of his left eye, visual acuity of 6/6 (R) and 6/24 (L), limited eye movements in all directions, with absent downward gaze.

MRI reported an extensive inflammatory phlegmon involving the medial and superior aspect of the left orbit with a peripherally enhancing phlegmon tissue causing the patient's proptosis (see figure 1).

Figure 1

MRI showing phlegmon involving the medial and superior aspect of the left orbit.

Flexible endoscopy found bilateral pus in the middle meatus with adhesions between the left lateral wall and the septum, and a small ethmoidal polyp on the left side.

A diagnosis of acute inflammatory sinusitis with associated intraorbital extension and associated phlegma of inflammatory change without evidence of intracranial complications was made.

This presentation of sinusitis is more common in the paediatric population, and is associated with the rare complication of Pott's Puffy tumour.1 It is important to consider sinusitis in the differential for periorbital swelling in the general population to prevent sinister complications.


  • Contributors LG wrote the original report which was reviewed and edited by RM and FC.

  • Competing interests None.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; internally peer reviewed.


Free sample
This recent issue is free to all users to allow everyone the opportunity to see the full scope and typical content of EMJ.
View free sample issue >>

Don't forget to sign up for content alerts so you keep up to date with all the articles as they are published.

Navigate This Article