Purpose: Quantitative and qualitative evaluation of facial asymmetry in patients with unilateral exotropia Duane Retraction syndrome (DRS) with head turn in comparison with normal subjects. Methods: The present cross-sectional study was performed on 22 samples, including 11 patients with unilateral exotropia DRS with a head turn and 11 normal subjects without torticollis as a control group. To evaluate the appearance of the face, from a distance of 40 cm, four photos of each sample were captured and analyzed, using Corel Draw X7 software. The presence of qualitative facial asymmetry parameters, including one-side compression of the nostrils, cheek and face, and columella deviation were recorded. Quantitative facial asymmetry parameters, including "relative face size" and "facial angle" were also measured. Results: The mean age of patients and normal subjects was 17± 10 and 18± 10, respectively. Two groups were matched by gender and age (P=0. 885, P>0. 99, respectively). All 11 (100%) exotropia DRS patients had facial asymmetry, but in the control group, facial asymmetry was observed in 6 (54. 5%) subjects, and 5 (45. 5%) subjects had perfectly symmetrical faces (P = 0. 736). The mean facial angle in the patient group (1. 7° ± 0. 016° ) was significantly higher than the control group (0. 8° ± 0. 8° ) (P= 0. 012). Also, the mean relative face size in the patient group (1. 022± 0. 016) was significantly higher than the control group (1. 008± 1. 006) (P = 0. 019). The frequency of all qualitative facial asymmetry parameters (one-side compression of the nostrils, cheek and face, and columella deviation) in the patient group was significantly higher than the normal control group (all, P <0. 001). Conclusion: All facial asymmetry parameters in exotropia DRS patients with head turns were significantly higher than the normal control group.