Impact of Septal Deviation and Sinonasal Variations on Nasolacrimal Duct Obstruction in PANDO and Chronic Dacryocystitis: A CT-Based Study

Objective To assess the relationship between nasal septal deviation characteristics, sinonasal variations, and nasolacrimal duct (NLD) obstruction in primary Acquired Nasolacrimal Duct Obstruction (PANDO) and chronic dacryocystitis. Methods A total of 142 patients (48 PANDO, 46 chronic dacryocystitis, 48 controls) who underwent paranasal sinus computed tomography were included. Septal deviation characteristics and sinonasal variations were evaluated. Associations with NLD obstruction were analyzed using univariate and multivariate logistic regression. Results The s eptal deviation was significantly associated with NLD obstruction (p = 0.005). Multivariate analysis identified a higher classification of Mladina (OR = 1.37, 95% CI = 1.10–1.71; p = 0.006) and a lower coronal deviation (OR = 1.73, 95% CI = 1.00–2.99; p = 0.049) as independent predictors. Other deviation parameters and sinonasal variations were not independently associated with laterality or severity obstruction. In deviation-positive patients, morphological features did not predict the obstruction side. Conclusions Inferior septal deviation and higher Mladina scores showed independent associations with NLD obstruction; however, the general contribution of septal morphology appears limited. These findings may have implications for preoperative evaluation and surgical planning in patients with PANDO and chronic dacryocystitis.