Aims: Sinogenic orbital infections are rare but vision-threatening complications of acute rhinosinusitis. Before antibiotics, sinusitis caused blindness in up to 20% of cases. The Royal Victorian Eye and Ear Hospital (RVEEH) uniquely manages both ophthalmic and ENT emergencies, providing a concentrated case load. This audit aimed to identify diagnostic pitfalls, management patterns, and learning points applicable to ENT surgeons in both tertiary and regional settings. Methods: A retrospective review of emergency presentations coded as orbital or periorbital cellulitis between May 2023 and May 2025 was undertaken. Demographic, radiological, microbiological, and management data were extracted from electronic records. Cases with confirmed sinogenic origin were analysed against RVEEH guideline standards. Results: Of 105 orbital inflammation presentations, 29 (28%) were sinogenic (≈1.2 cases/month), markedly lower than the 60–80% reported in the literature. Mean age 48 years; 66% female. Half lacked sinusitis symptoms, and 17% had a normal nasoendoscopy. Eighty-six percent were admitted for intravenous antibiotics (mean stay 3 days) and 20% had emergency surgery (mean 2.7 days). Staphylococcus aureus was most common. Only 28% received full guideline-compliant intravenous antibiotics (ceftriaxone + flucloxacillin + metronidazole). Conclusions: Sinogenic orbital infections remain uncommon but can present subtly. Early imaging, multidisciplinary assessment, and adherence to empiric antibiotic protocols are critical to prevent vision loss and intracranial complications. Key Learning Points for ENT Surgeons: 1.Up to 50% of orbital infections may lack sinus symptoms — do not rely on clinical findings alone. 2.Perform early CT for any unexplained orbital swelling. 3.Ensure anaerobic cover (metronidazole) in empirical regimens. 4.ENT–ophthalmology co-management improves diagnostic speed and outcomes. 5.Standardised protocols can reduce variability and enhance safety.