A Paranasal Sinuses (PNS) X-ray in Water’s view (also called a sinus X-ray or Waters view face) is a plain X-ray image taken with your head positioned in a specific way to best show the maxillary sinuses (cheek sinuses) and, to some extent, the frontal (forehead) and ethmoid (between the eyes) sinuses. This specialized projection is often described as a maxillary sinus film because it is optimized to look for problems in and around the maxillary sinuses.

The test does not “measure” blood values or infection markers. Instead, it creates an image of the air-filled spaces in your face (the sinuses) and the surrounding bones. On a Water’s view PNS X-ray, a radiologist looks for:

• Normal findings: sinuses appear mostly dark/black because they are filled with air, with thin bony outlines.
• Possible sinus infection or inflammation: mucosal thickening (lining looks thicker/whiter than usual) and/or a fluid level (a straight line showing fluid sitting under air) can suggest acute sinusitis, especially when symptoms match.
• Blockage or chronic disease signs: persistent “cloudiness” (increased whiteness) or reduced aeration may be seen with chronic sinusitis or nasal/sinus obstruction.
• Injury: fractures of facial bones—particularly around the maxillary sinus/orbit—may be suspected if there is facial trauma.

Because an X-ray is a 2D image, mild sinus disease may not always be visible. Depending on your symptoms, your clinician may recommend CT of the sinuses for more detail, especially for chronic sinus problems, complications, or pre-surgical planning.

Doctors commonly order a PNS X-ray (Water’s view) when symptoms suggest sinus disease or when facial injury needs a quick evaluation. It may be recommended for:

Sinus-related symptoms (especially if symptoms are moderate-to-severe, persistent, or not improving with treatment), such as:

• Facial pain or pressure (cheeks, around eyes, forehead)
• Nasal congestion or blockage
• Thick nasal discharge (yellow/green) or post-nasal drip
• Headache with sinus pressure features
• Reduced sense of smell (hyposmia)
• Fever with sinus symptoms or suspected acute bacterial sinusitis

After facial trauma to assess for possible fractures, including:

• Injury to the cheekbone/upper jaw region (maxillary area)
• Swelling, bruising, or tenderness over the sinuses or around the eyes
• Suspected orbital floor or midface injury (often evaluated further with CT if concern is high)

Follow-up or evaluation of recurrent issues when a clinician needs an initial imaging look at the sinuses, such as recurrent sinus infections or suspected obstruction.

Important note for patients: symptoms alone often guide treatment for uncomplicated acute sinusitis, and many cases are viral. Imaging (including a sinus X-ray) is more likely to be used when symptoms are severe, prolonged, atypical, or when complications or injury are a concern.

• Acute sinusitis (especially acute maxillary sinusitis)
• Chronic rhinosinusitis
• Sinus fluid level from infection/inflammation
• Nasal polyps or sinonasal obstruction (suggested indirectly by poor sinus aeration)
• Allergic rhinitis with secondary sinus inflammation
• Facial bone fractures involving the maxilla or midface (trauma-related)
• Odontogenic (dental-related) maxillary sinusitis
• Retention cyst or mucous thickening in the maxillary sinus (often incidental)

• Identifying a likely cause of persistent facial pressure, congestion, or recurrent “sinus headaches”
• Supporting diagnosis and treatment decisions for suspected acute bacterial sinusitis (when clinically indicated)
• Checking for complications or structural concerns after facial trauma
• Evaluating recurrent sinus symptoms to guide next steps (e.g., medical therapy vs. ENT referral, need for CT)
• Monitoring response when symptoms persist despite treatment and a clinician needs imaging context