What could be causing front-sided headaches, eye discharge, mild blurred vision, and a congested nostril, and how should it be treated?

Acute Rhinosinusitis with Possible Allergic Component

This presentation is most consistent with acute viral rhinosinusitis with possible allergic rhinitis, and should be managed with symptomatic treatment including saline irrigation, oral decongestants with first-generation antihistamines, and NSAIDs for pain—antibiotics are NOT indicated at this stage. 1, 2

Clinical Diagnosis

Your symptom cluster of frontal headache, eye discharge, mild blurred vision, and unilateral nasal congestion lasting only a few days strongly suggests acute viral rhinosinusitis, which accounts for 98-99.5% of acute rhinosinusitis cases. 3 The key diagnostic features include:

• Bilateral frontal headache with pressure-like quality is the typical pattern for viral upper respiratory infection 1
• Eye discharge and mild blurred vision represent associated allergic conjunctivitis, which commonly accompanies rhinitis 4
• Clear or colored nasal discharge alone does not indicate bacterial infection—green mucus simply reflects white blood cells and desquamated epithelium from normal viral inflammation 1, 3
• Symptoms present for only 3 days without "double sickening" pattern (initial improvement followed by worsening) confirms viral rather than bacterial etiology 1

Why This is NOT Bacterial Sinusitis Yet

Acute bacterial rhinosinusitis (ABRS) requires one of three patterns: symptoms persisting ≥10 days without improvement, symptoms worsening after initial improvement within 5-7 days, or severe symptoms with high fever (>39°C) and purulent discharge for 3-4 consecutive days. 4, 3 You don't meet any of these criteria yet.

Recommended Treatment Protocol

First-Line Symptomatic Management

• High-volume saline nasal irrigation 2-3 times daily—this has no rebound effect and provides excellent mucociliary clearance 1, 3
• Ibuprofen 400-600mg every 6-8 hours as needed for headache and facial pressure 1
• First-generation antihistamine combined with oral decongestant every 4-6 hours for congestion 1, 2
• If using topical decongestant spray, limit to 3-5 days maximum to avoid rhinitis medicamentosa (rebound congestion) 1

Treatment for Associated Eye Symptoms

The eye discharge and blurred vision represent allergic conjunctivitis accompanying your rhinitis. 4 Treatment options include:

• Intranasal corticosteroids are equally effective as oral antihistamines for relieving ocular symptoms associated with rhinitis 4
• Topical ophthalmic antihistamine drops can be added for specific eye symptom relief 4
• The oral antihistamine recommended above will also help your eye symptoms 4

Critical Red Flags Requiring Immediate Medical Attention

Return immediately or go to the emergency department if you develop: 1, 2, 3

• Symptoms persist >10 days without improvement (suggests bacterial sinusitis)
• Symptoms worsen after initial improvement within 5-7 days (double-sickening pattern)
• High fever >39°C (102.2°F) with severe unilateral facial pain
• Severe headache with neck stiffness (meningeal signs)
• Vision changes beyond mild blurriness—diplopia, vision loss, or eye pain with movement
• Periorbital swelling, redness, or proptosis (orbital complications)
• Mental status changes or confusion
• Facial swelling or erythema suggesting cellulitis

Why Antibiotics Are NOT Indicated Now

Only 0.5-2% of acute rhinosinusitis cases are actually bacterial, and 60% of presumed bacterial cases resolve spontaneously without antibiotics. 3 The number needed to treat with antibiotics in acute rhinosinusitis is 18, while the number needed to harm is 8—meaning you're more likely to experience antibiotic side effects than benefit. 2

Starting antibiotics now would represent poor antibiotic stewardship and expose you to unnecessary risks including antibiotic resistance, C. difficile infection, and allergic reactions. 2

If Symptoms Progress to Bacterial Sinusitis

Should your symptoms persist beyond 10 days or worsen after initial improvement, bacterial sinusitis becomes likely and requires: 3

• Amoxicillin 500mg three times daily for 10-14 days as first-line treatment (covers Streptococcus pneumoniae and Haemophilus influenzae)
• High-dose amoxicillin-clavulanate if no improvement by day 7
• No imaging needed for uncomplicated cases—CT is reserved for suspected complications or treatment failure 3

Common Pitfalls to Avoid

• Don't assume green mucus means bacterial infection—color relates to neutrophils, not necessarily bacteria 3
• Don't use topical decongestants beyond 3-5 days—this causes rebound congestion that's worse than the original problem 1
• Don't ignore worsening symptoms—the "double-sickening" pattern (improvement then worsening) is the hallmark of bacterial superinfection 1, 3