Aim and objective: To emphasize the infrequent scenarios associated with orbital complications of rhinosinusitis. Background: Orbital sterile collections leading to functional limitation including diplopia can occur in patients with inadequately treated rhinosinusitis and require timely detection followed by definitive management. Case description: We present a case of a previously healthy male with sudden onset left eye proptosis and diplopia of 2 weeks duration referred after endoscopic sinus surgery. Contrast-enhanced magnetic resonance imaging confirmed an organized collection with rim enhancement in the inferior orbit. Endoscopic drainage of the collection along with a microbiological and histopathological examination of the specimen was done. The patient had immediate postoperative alleviation of symptoms. Specimen culture revealed no microbiome growth which was suggestive of a sterile collection or an antibioma. A regular follow-up for a duration of 5 months showed no evidence of residual disease postprocedure and complete recovery. Conclusion: Adequate drainage of the sinuses and orbital abscess with antibiotic coverage during initial surgery with prompt imaging and also ruling out fungal etiology would best treat the orbital complications of acute rhinosinusitis. Clinical significance: Orbital complications of acute rhinosinusitis can be persistent despite treatment and should arise suspicion of residual or recurrent disease. Fungal disease should be ruled out and prompt imaging is helpful in diagnosis. Endonasal endoscopic surgery whenever feasible gives the best results.