Complication | Clinical features | Imaging evaluation* |
Preseptal cellulitis | Ocular pain, eyelid swelling, and erythema | Clinical diagnosis (imaging usually not needed unless there is concern for orbital cellulitis) |
Orbital cellulitis | Ocular pain, eyelid swelling, and erythema plus pain with eye movements, proptosis, or visual changes suggesting involvement of the orbital tissue | CT with contrast or MRI without and with contrast of the head, including the orbit and paranasal sinuses |
Subperiosteal abscess | Displacement of the globe, in addition to symptoms of orbital cellulitis | MRI without and with contrast of the head, orbit, and paranasal sinuses |
Intracranial abscess | Headache with or without altered mental status, fever, or nausea/vomiting | CT with contrast or MRI without and with contrast of the head and paranasal sinuses |
Meningitis | Fever, neck stiffness, and/or altered mental status | CT of the head without contrast may be indicated prior to lumbar puncture¶ |
Septic cavernous sinus thrombosis | Cranial nerve palsies (CN III, IV, VI) with or without headache and fever | MRI without and with contrast of the head and paranasal sinuses. MR venography either without or with contrast. |
Osteomyelitis | Dull pain at involved site often with overlying tenderness, erythema, or swelling | CT with contrast or MRI without and with contrast of the head and paranasal sinuses |