• Highland Health and Social Care Partnership
  • Primary and Secondary Care

Signs and symptoms


  • Lid swelling
  • Decreased vision
  • Double vision
  • Feels unwell; often preceding Upper Respiratory Tract Infection


  • Decreased visual acuity
  • Proptosis
  • Lid swelling
  • Conjunctiva red and chemosed
  • Reduced ocular motility
  • May have afferent pupillary defect
  • Pyrexia


  1. Admit under ENT, Raigmore if adult (Paediatric Ward if a child) for Senior ENT assessment
  2. Ophthalmic assessment - visual acuity, colour vision, pupil reactions, ocular motility
  3. IV access
  4. FBC, U&Es, PV, CRP and blood culture
  5. IV antibiotics – Cefotaxime and Flucloxacillin
  6. Otrivine nasal drops (not under 2 years old)
  7. 4 hourly neuro obs
  8. Emergency CT scan of Brain and Orbits if impairment on eye examination
  9. Arrange for follow up with Ophthalmology that day or, if out of hours, the following day


  • CRP: C-reactive protein
  • CT: Computed tomography
  • ENT: Ear, nose and throat
  • FBC: Full blood count
  • IV: Intravenous
  • NTC: National Treatment Centre
  • PV: Plasma viscosity
  • U&E: Urea and electrolytes

Editorial Information

Last reviewed: 14/02/2023

Next review date: 28/02/2026

Author(s): Ophthalmology Review Group.

Version: 1.1

Approved By: TAM subgroup of the ADTC

Reviewer name(s): Dr T Leslie, Consultant Ophthalmologist.

Document Id: TAM554