Orbital infection has long been the most common complication of sinusitis. In light of our increased knowledge of sinusitis, improved diagnostic tools, and new pharmacologic and surgical treatments, we investigated whether trends in diagnosis and treatment are changing. We reviewed the charts of all 43 patients who had been referred to our institution with orbital complications of sinusitis between Jan. 1, 1985, and Dec. 31, 1999. Nine of the 43 patients had been diagnosed between Jan. 1, 1985, and Dec. 31, 1990 (mean: 1.5 patients/yr) and 34 had been diagnosed between Jan. 1, 1991, and Dec. 31, 1999 (mean: 3.8 patients/yr). Of the 43 patients, 27 had cellulitis and 16 had an abscess (one of the 16 had two abscesses--one subperiosteal and one supraorbital). All 17 abscesses were treated surgically. Five of the 7 abscesses operated on from 1985 through 1990 were treated via an open external approach, whereas 7 of the 10 abscesses that were operated on later were treated via an endoscopic approach. We conclude that orbital complications of sinonasal origin are being recognized more frequently than they were in the past and that endoscopy has supplanted the open external approach as the preferred method of drainage.