Background <p>Unresolved facial asymmetry remains a common cause of postoperative dissatisfaction after rhinoplasty, and eyes are key determinants of asymmetric perception. Although the nose is considered the central pivot of facial development, the relationship between nasal septal deviation and ocular or orbital asymmetry has not been clearly defined. This study aimed to evaluate the association between septal deviation and vertical eye-level asymmetry using computed tomography (CT)-based skeletal analysis.</p> Methods <p>Fifty two patients undergoing primary rhinoplasty were analyzed retrospectively. Eye asymmetry and dorsal deviation (DD) were assessed using frontal photographs. Bony septal deviation (BSD) and cartilaginous septal deviation (CSD) were measured by facial bone CT scans. Orbital parameters, including superior orbital rim (SOR) level, inferior orbital rim (IOR) level, orbital area difference, and facial width/length, were quantified using PACS-based 3D reconstruction. Statistical analyses included Chi-square tests, correlation analyses, and regression.</p> Results <p>Eye asymmetry was present in 63.5% of the patients. DD (<i>p</i> &lt; 0.001) and BSD (<i>p</i> = 0.044) were significantly associated with eye asymmetry, whereas CSD was not. Orbital asymmetry on CT also strongly correlated with eye asymmetry (<i>p</i> &lt; 0.001). Degree of BSD demonstrated significant associations with that of DD (<i>ρ</i> = 0.277, <i>p</i> = 0.047), SOR asymmetry (<i>β</i> = 0.194, <i>p</i> &lt; 0.001), and orbital area difference (<i>ρ</i> = 0.413, <i>p</i>=0.002). IOR asymmetry and facial width/length parameters showed no significant correlations.</p> Conclusions <p>Eye asymmetry reflects underlying midfacial skeletal imbalance and shows a significant association with bony septal deviation. Among various orbital parameters, SOR height and orbital area asymmetry demonstrated the strongest correlations with the degree of BSD, suggesting that these factors contribute substantially to overall facial asymmetry. Incorporating orbital skeletal assessment into preoperative facial analysis may improve diagnostic accuracy, surgical planning for rhinoplasty, and postoperative satisfaction.</p> Level of Evidence III <p>This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine Ratings, please refer to Table of Contents or online Instructions to Authors <a href="http://www.springer.com/00266">www.springer.com/00266</a>.</p>