With the new antibiotics, visual loss following acute sinusitis is becoming infrequent. However, because of the severity of these cases, immediate diagnosis and treatment is necessary to prevent permanent damage. Visual loss can be due to extension of an orbitary infection or superior orbitary apex syndrome. Visual alterations associated with acute sinusitis are rhinologic emergencies, requiring quick diagnosis and therapeutic management. Usually, delayed surgical interventions are due to inconclusive CT scans which do not allow an adequate differentiation between orbitary cellulitis or abscess. In these cases, the visual evaluation dictates the correct timing of the procedure. We report the case of a young man with no concomitant diseases, who developed irreversible visual loss following acute sinusitis, despite the immediate and aggressive treatment.