Chandler Classification of Orbital Complications of Acute Sinusitis:


Chandler Class Stage Description
I Inflammatory Edema (Pre-septal cellulitis)
  • Eyelid edema and erythema
  • Normal extraocular movements
  • Normal visual acuity
II Orbital Cellulitis
  • Diffuse edema of orbital content but no abscess
  • Extraocular movements may be limited
III Subperiosteal Abscess
  • Collection of contrast enhancing mass beneath periosteum of lamina papyracea
  • Displacement of globe downward or laterally
IV Orbital Abscess
  • Collection of contrast enhancing mass in the orbit
  • Proptosis
  • Chemosis
  • Ophthalmoplegia
  • Decreased vision
V Cavernous Sinus Thrombosis
  • Bilateral eye findings
  • Prostration
  • Meningismus


Chandler JR, Langenbrunner DJ, Stevens ER. The pathogenesis of orbital complications in acute sinusitis. Laryngoscope. 1970;80(9):1414-28.