What is a sinus infection?
Sinus infection (sinusitis or rhinosinusitis) is characterised by swelling and irritation of the nasal cavity that can lead to a build-up of fluid in the air-filled cavities of the face, known as paranasal sinuses around the nose.
This fluid accumulation provides a fertile breeding ground for germs (bacteria and fungi) to proliferate and trigger an infection. The main symptoms of sinusitis include:
- facial pain or pressure,
- sinus headache,
- fever,
- feeling unwell,
- fatigue,
- cough,
- nasal congestion,
- mucus discharge from the nose (rhinorrhoea),
- and mucus in the back of the throat (postnasal drip) [1, 2].
What are the causes of a sinus infection?
Sinus infections often stem from viruses and linger, especially for adults, even after other upper respiratory symptoms have gone away. Bacteria or, very rarely, fungi may also cause sinus infections. Viruses cause nine out of 10 adult sinus infections; bacteria cause less than 2% [3, 4].
Potential causes of blocked sinuses and, therefore, the risk of sinus infection include the common cold, hay fever and other allergens, and changes in air pressure. Other causes of sinusitis include allergies, exposure to chemical irritants, asthma, colds or weather changes, and a compromised immune system [5, 6].
Sometimes, sinusitis can begin as a regular viral cold and become an infection. Some nasal issues, allergies, and diseases can also cause acute and chronic sinusitis [2].
What are the causes of sinus infection and eye discharge?
The eye discharge in sinus infection cases can be due to several reasons. The first possible reason is a bacterial infection. Any disease of the maxillary sinuses can spread through the surrounding structures facilitated by increased capillary permeability and an influx of white blood cells. The resulting sinusitis can lead to an eye discharge, which is "booger-like" and can also be referred to as an eye booger sinus infection. Bacterial agents responsible include Streptococcus pneumoniae, Hemophilus influenzae, Staphylococcus aureus, Streptococcus pyogenes among others [7, 8].
Infections can also invade adjacent ethmoid sinuses due to anatomical features such as a fragile medial wall, lack of lymphatics, orbital foramina and septic thrombophlebitis of the valveless veins between the two [9].
Another is nasal inflammation and oedema that occurs during sinus infections. These can lead to a blockage of the sinuses, pain in the face, and discolouration of the eyes [5].
Allergic triggers can also bring on sinus infections and eye discharge. When we breathe, eat, or even touch substances we’re allergic to, our body experiences an inflammatory response as if they were a bacterial invader, resulting in runny noses (and, for many people, runs from the other end) and an accompanying drippy eye discharge [10].
In some cases, sinus infections have invaded the bones and soft tissues that encircle the face and eye sockets. To address this problem, the treatment invariably consists of antibiotics [5].
In rare cases, it can flood the optic nerve, causing eye discharge [11].
Sinusitis is a common disease in immunocompromised patients, and pathogenic organisms are mostly bacterial and fungal in origin. When these pathogens invade the sinuses, they may penetrate the orbit and cause eye discharge [12].
Treatment for sinus infection eye discharge
The primary treatment to get rid of eye discharge from a sinus infection is to get rid of the sinus infection. This is done through medications as well as supportive care.
Antibiotic therapy is the first line of treatment, mainly if there is a bacterial cause, a large amount of pus, or if symptoms continue for at least ten days without improvement, or symptoms improve within ten days and then rapidly worsen again. In these cases, doctors may prescribe amoxicillin or another first-line antibiotic [1].
Antibiotics for bacterial sinusitis and intranasal decongestion sprays such as oxymetazoline can also be helpful for short-term symptomatic relief. However, the development of rebound symptoms will occur if users have an intranasal decongestion spray for more than three days. Steroid nasal sprays such as fluticasone (Flonase) or triamcinolone may relieve nasal congestion symptoms without risk of rebound symptoms from long-term use [1].
Bacterial eye infections are generally treated by prescription antibiotics, usually by eye drops in case of eye discharge, and sometimes complemented by oral antibiotics if prescription drops are insufficient [13].
Sometimes, surgery is needed in those cases due to complications stemming from sinusitis, such as a subperiosteal orbital abscess [14].
Is a sinus infection and eye discharge dangerous?
Sinus infections can result in severe complications if not appropriately and promptly treated, such as an orbital infection of the eye and associated structures. Orbital infections are usually a complicating factor of paranasal sinus infections with severe complications and even death if not treated promptly [15].
Typical symptoms of orbital infections may include decreased visual acuity and ophthalmoplegia (paralysis or weakness in the muscle innervations responsible for eye movement) [16, 17]. In the worst-case scenario, these infections can lead to vision loss or impairment.
In a case series of patients with orbital complications of chronic sinusitis, 75% presented with pre-septal cellulitis – inflammation and infection of the eyelid and the skin around the eye – while 25% presented with a frontal sinus fistula – an abnormal connection between parts of the frontal sinus and either the skin or another organ [18].
Sinusitis, especially orbital complications, is considered a severe pathology. The presence of eyelid swelling in the corner of the eye should be taken seriously, and one method of excluding acute sinusitis should be implemented [19].
In short, while the majority of cases of sinus infections are not life-threatening and tend to resolve spontaneously, their complications are. They can lead to orbital infections with frightening symptoms and sight-threatening complications such as pus discharge from the eye ("booger-like"), worsening vision, and even blindness. Therefore, the rule of thumb would be, if you have a sinus infection and get any eye symptoms, risk it and see your eye doctor.