A 9-year-old boy with acute ethmoiditis develops marked periorbital swelling, chemosis, and lateral displacement of the globe, but vision is normal and there is no afferent pupillary defect. CT orbits show a rim-enhancing collection along the lamina papyracea displacing the medial rectus. According to the Chandler classification, what stage of orbital complication is present?

• A Stage II, orbital cellulitis
• B Stage V, cavernous sinus thrombosis
• C Stage IV, orbital abscess
• D Stage III, subperiosteal abscess ✓

Explanation

A collection between the lamina papyracea and periorbita that displaces the globe laterally and outward is a subperiosteal abscess, Chandler stage III. Stage II orbital cellulitis shows diffuse inflammatory edema without a drainable collection, stage IV implies pus within the orbit proper causing painful ophthalmoplegia and visual loss, and stage V adds bilateral involvement, cranial nerve palsies and high fever from cavernous sinus spread.

Reference: Cummings Otolaryngology: Head and Neck Surgery, 7th ed.

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Written and medically reviewed by the StethoPrep medical team.