Association of facial asymmetry and nasal septal deviation in acquired nasolacrimal duct obstruction in East Asians

PURPOSE: The objective of this study was to evaluate the association of facial asymmetry and nasal septal deviation in acquired unilateral nasolacrimal duct (NLD) obstruction. METHODS: A retrospective survey was conducted of 39 patients (6 male and 33 female) who had undergone endoscopic dacryocystorhinostomy at the Korea University Ansan Hospital. Patients with trauma to the orbit or any known lacrimal duct disease were excluded. The primary goal was to obtain a descriptive analysis of facial asymmetry and nasal septal deviation. We analyzed the results and identified associations with facial asymmetry and nasal septal deviation in NLD obstruction and determined the influence of the degree of asymmetry and deviation on the results. RESULTS: The mean length of the straight line drawn from the lateral canthus to the corner of the mouth was 10.2 cm in the right eye and 9.9 cm in the left eye, and the difference was statistically significant by the Wilcoxon signed rank test (P = 0.043). The laterality of NLD obstruction corresponded to the smaller side of the face in 27 of 39 patients (P = 0.038, κ = 0.753 by cross-table McNemar test). Also, a significant positive linear relation of correspondence of NLD obstruction to the smaller side of the face was observed according to the degree of facial asymmetry (P = 0.043 by linear-by-linear association). Nasolacrimal duct obstruction appeared to occur on the side in which the nasal septum was deviated in 25 of 39 patients (P = 0.043, κ = 0.652 by cross-table McNemar test). Significant positive linear relation of correspondence of NLD obstruction to the side in which the nasal septum was deviated was also observed according to the degree of nasal septal deviation (P = 0.045 by linear-by-linear association). There is also a trend of nasal septal deviation toward the smaller side of the face (total 25 of 39 patients, P = 0.043 by cross-table McNemar test). CONCLUSIONS: Unilateral NLD obstruction appears to occur on the side in which the nasal septum is deviated, and nasal septal deviation tends to be toward the smaller side of the face. Also, the degree of facial asymmetry and nasal septal deviation may affect NLD obstruction. This study showed that facial asymmetry and nasal septal deviation could be a cause of unilateral NLD obstruction. This finding can aid in differentiating lacrimal duct obstruction, especially when combined with physical examination.