The clinical picture of an acute orbit, as manifest by preseptal cellulitis, subperiosteal abscess or orbital cellulitis, is still frequently seen in ENT practice. The commonest cause is sinusitis and the authors advocate early surgical intervention in acute orbits due to sinusitis. Clinically, it can be difficult to distinguish between a subperiosteal abscess and orbital cellulitis and a CAT scan may be helpful. Surgically, a subperiosteal abscess is the more important (and probably more frequent) entity as it may require drainage. It may be suspected in an acute orbit which progresses rapidly or fails to settle on treatment and it may require drainage to allow the condition to resolve and avoid potentially damaging sequelae. A classification of the stages of the inflammatory processes seen in the acute orbit is given and the management of 34 cases due to sinusitis is discussed. The other causes of acute orbits are discussed and the further complications that may occur are also mentioned. Blindness, cavernous sinus thrombosis and cerebral involvement are still frequently recorded and death may still occur.