Orbital Decompression Surgery for Thyroid Eye Disease

Q: What does orbital decompression do?

It removes part of the bony walls (and sometimes fat) of the eye socket to create more room, allowing a proptotic (bulging) eye to settle back and relieving pressure on a compressed optic nerve.

Q: When is orbital decompression needed urgently?

When the optic nerve is being compressed (dysthyroid optic neuropathy) with failing vision, or when severe proptosis prevents the eyelids from closing and threatens the cornea.

Q: Can decompression cause double vision?

It can change eye alignment, which is why decompression is performed first — any resulting double vision is then corrected with strabismus surgery, followed by eyelid surgery.

Surgery that enlarges the bony orbit to relieve proptosis and optic-nerve compression in thyroid eye disease — the first step of rehabilitative surgery.

Medically reviewed by EyePlastics Medical Editorial BoardASOPRS oculoplastic surgeonsLast updated June 2026

Part of our complete guide to Thyroid Eye Disease (TED) — this page covers orbital decompression surgery in depth.

Orbital decompression is the first and most fundamental of the rehabilitative operations for thyroid eye disease. By enlarging the bony eye socket it relieves a bulging eye and, when needed, pressure on the optic nerve.

Orbital Decompression

Explore orbital anatomy, clinical findings, and the medial wall, lateral wall, and floor decompression surgical techniques.

Orbital DecompressionSurgical Animation

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In order to create additional space on the outer orbit, the surgeon may remove some of this bone with (as seen here) or thin the bone in this area.

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Orbital decompression creates additional volume within the orbit by removing one or more orbital walls, allowing the expanded orbital contents to bulge into the adjacent sinuses. This reduces proptosis, relieves corneal exposure, and — crucially — decompresses the optic nerve when vision is threatened.

Indications

Compressive optic neuropathy — urgent or emergency decompression to prevent irreversible vision loss
Severe proptosis with corneal exposure not controlled by medical means
Cosmetic/rehabilitative improvement of disfiguring proptosis once the disease is inactive and stable (typically Clinical Activity Score < 3 for several months); rehabilitative surgery follows a staged sequence of decompression first, then strabismus surgery, then eyelid surgery
Preparation for strabismus surgery (changing orbital volume may affect alignment)

Surgical Approach

Your oculoplastic surgeon tailors the approach to each patient’s CT anatomy, severity, and goals:

Medial wall decompression: Removes the lamina papyracea (thin paper bone between orbit and ethmoid sinuses). Excellent for optic nerve decompression; 2–4 mm proptosis reduction per wall
Orbital floor decompression: Opens the floor into the maxillary sinus; additional 2–4 mm reduction
Lateral wall decompression: Opens into the temporal fossa; significant volume; lower risk of new diplopia compared to medial/floor
3-wall balanced decompression: Used for severe proptosis; may combine medial, floor, and lateral walls for maximum effect (6–10 mm proptosis reduction)

Risks & Recovery

New or worsened diplopia is the most common significant complication — medial wall decompression carries the highest risk; balanced decompression with lateral wall reduces this
Infraorbital numbness (cheek, upper lip) — usually temporary, lasting weeks to months
CSF leak (rare) when decompressing near the skull base
Vision often stabilizes or improves when surgery is performed promptly for optic neuropathy, though recovery is not guaranteed and depends on the duration and severity of nerve compression; elective cosmetic decompression carries a very low risk of vision loss

Frequently Asked Questions

What does orbital decompression do?: It removes part of the bony walls (and sometimes fat) of the eye socket to create more room, allowing a proptotic (bulging) eye to settle back and relieving pressure on a compressed optic nerve.
When is orbital decompression needed urgently?: When the optic nerve is being compressed (dysthyroid optic neuropathy) with failing vision, or when severe proptosis prevents the eyelids from closing and threatens the cornea.
Can decompression cause double vision?: It can change eye alignment, which is why decompression is performed first — any resulting double vision is then corrected with strabismus surgery, followed by eyelid surgery.

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Frequently Asked Questions

What does orbital decompression do?

It removes part of the bony walls (and sometimes fat) of the eye socket to create more room, allowing a proptotic (bulging) eye to settle back and relieving pressure on a compressed optic nerve.

When is orbital decompression needed urgently?

When the optic nerve is being compressed (dysthyroid optic neuropathy) with failing vision, or when severe proptosis prevents the eyelids from closing and threatens the cornea.

Can decompression cause double vision?

It can change eye alignment, which is why decompression is performed first — any resulting double vision is then corrected with strabismus surgery, followed by eyelid surgery.