Medically reviewed by Dr. Niranjana Bejan Singh. Written to established clinical-education standards (AAO/Mayo/NHS/NEI) and adapted for this hospital. Not a substitute for professional medical advice.
Orbital decompression is a surgery that creates more space within the bony eye socket (orbit) to relieve pressure on the eye and optic nerve, or to allow a bulging eye to settle back into a more normal position. It is most often performed for thyroid eye disease (also called Graves' orbitopathy), a condition in which the tissues and muscles behind the eye swell and push the eyeball forward. The surgeon removes a portion of the bone and/or fat around the eye socket to give the swollen tissues room to expand outward instead of pressing on the eye and optic nerve.
Who typically needs this
- Patients with thyroid eye disease whose optic nerve is being compressed, threatening vision — this is treated urgently.
- Patients with significant eye bulging (proptosis) causing exposure of the eye surface, discomfort, or difficulty closing the eyelids fully.
- People whose thyroid eye disease has stabilised (is no longer actively worsening) but has left them with a cosmetically or functionally troublesome bulge.
- Those with severe eye pressure, pain, or double vision related to crowding within the orbit, once other causes have been ruled out.
What to expect
- Before surgery, imaging (CT or MRI) of the orbit is reviewed to plan how much bone and fat needs to be removed and from which walls of the socket.
- The operation is done under general anaesthesia and can address one or both eye sockets depending on the disease.
- Access is usually gained through incisions hidden inside the eyelid or in a natural skin crease, so external scarring is minimal.
- The surgeon removes portions of the orbital bone and/or excess orbital fat to create additional space.
- The tissues are allowed to shift into the newly created space, which reduces pressure on the optic nerve and lets the eye settle to a less prominent position.
Recovery
- Swelling and bruising around the eyes are significant initially and can take several weeks to substantially improve.
- Temporary double vision is common after surgery, because shifting the eye's position can unmask or change pre-existing muscle imbalance; this often needs separate evaluation and sometimes further treatment later.
- Numbness of the cheek or upper teeth can occur if bone near certain nerves is removed, and usually improves gradually over months.
- Most patients need several weeks before returning to normal activity, and full settling of the eye position and surrounding tissues can take some months.
Risks to know about
- New or worsened double vision is a recognised and relatively common risk, sometimes requiring separate eye muscle surgery afterward.
- Numbness of the cheek, upper lip, or teeth can occur and is usually temporary but is occasionally long-lasting.
- Rare but serious risks include cerebrospinal fluid leak, significant bleeding, or vision loss, given the proximity to the sinuses, brain, and optic nerve.
- Results may be asymmetric between the two eyes, and further fine-tuning surgery (on the eye muscles or eyelids) is often planned as part of the overall treatment sequence.
Frequently asked questions
Is orbital decompression only for vision-threatening cases?
No — it can be done urgently to protect the optic nerve, or electively once thyroid eye disease has stabilised, mainly to reduce bulging and improve comfort and appearance.
Will my double vision go away after surgery?
Existing double vision may improve, stay the same, or occasionally appear for the first time after decompression; many patients need a separate eye muscle surgery afterward to fully correct alignment.
How much smaller will my eye bulge look?
The degree of improvement varies with how much bone and fat is removed and the severity of the original bulging; the surgeon can give an individual estimate based on imaging.
Do I need my thyroid condition controlled before this surgery?
Yes, thyroid hormone levels are generally stabilised with an endocrinologist before elective orbital surgery is planned, since active thyroid disease affects healing and outcomes.
Ready to see us?
Call the appointment desk, or book online — we will confirm your time by phone.
Sources consulted: AAO — What Is Thyroid Eye Disease?, NHS — Thyroid eye disease . General medical information — not a substitute for professional diagnosis. Medically reviewed by Dr. Niranjana Bejan Singh.
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