Superior Nasal Septal Deviation as a Contributing Factor for Dacryocystitis.

Background Dacryocystitis (DC) is a disease most often caused by an obstruction of the nasolacrimal duct, leading to over-accumulation of tears in the lacrimal sac, epiphora, and aseptic inflammation. External and endoscopic dacryocystorhinostomy (DCR) aims to restore the tear pathway by creating a bypass from the lacrimal sac to the nose. The aim of this study is to investigate superior nasal septal deviation as a possible contributing factor in the incidence and treatment of dacryocystitis. Methods This retrospective study included 36 patients surgically treated for chronic dacryocystitis from September 2019 to September 2024. Results Twenty-eight out of the 36 studied patients (77.8%) were females. The average age of all patients was 66.8 years, with 69.4% being in the 50-70 years age group while 30.6% being older than 70 years. Superior nasal septal deviation was present in all patients, with 18 (50%) cases being towards the side of the DC and 11 (30.6%) away from the side of the DC. In seven cases (19.4%), the septum was S-shaped. In none of the cases in which the endoscopic approach was used was a septoplasty necessary. Concha bullosa was observed in five cases (13.9%) and was treated in all. A total of 32 patients were treated endoscopically (88.9%) and four (11.1%) by the Toti external approach method. The intraoperative microbiologic culture was positive in a total of nine cases (25%), five being coagulase-negative Staphylococci (13.9%), two being S. pneumoniae (2.8%), and one each of S. aureus (2.8%) and Pseudomonas maltophilia (5.6%). A re-stenosis was observed in five patients (13.9%). Conclusion Superior nasal septal deviation is an emerging factor both for the incidence of dacryocystitis and the development of re-stenosis after dacryocystorhinostomy. Further studies are needed to find the exact types of nasal septum deviations carrying the greatest risk for disease development, as well as the role of septoplasty in the result of treatment.