About the Procedure
The eye sits inside a bony socket called the orbit, which shares walls with the sinuses and nose. When tissue behind the eye swells or enlarges, the eye can be pushed forward, pressure can build, and in some cases the nerve that carries vision can be compressed. Orbital decompression is a procedure that creates more space within or around the orbit by carefully removing portions of bone, fat, or both, allowing the eye to settle back and relieving pressure.
The most common reason for orbital decompression is thyroid eye disease (also called Graves' orbitopathy), where inflammation enlarges the muscles and fat behind the eye. Decompression may also be considered for certain tumors, infections, or trauma that crowd the orbit. The decision to operate, and the timing, depends on whether the problem is mainly cosmetic, uncomfortable, or threatening vision.
At Norelle Health, orbital decompression is planned together with ophthalmology. Evaluation includes a detailed eye examination and imaging so that the goals of surgery, the route used, and the risks are matched to each person rather than applied the same way to everyone.
Why decompression is performed
Orbital decompression is performed to make room for an eye that has been crowded forward or placed under pressure. The goals depend on the situation and may include:
- Relieving pressure on the optic nerve to protect vision
- Allowing the eyelids to close so the eye surface stays protected
- Reducing bulging (proptosis) that causes discomfort or eye exposure
- Easing pain or a feeling of pressure behind the eye
Not everyone with a prominent eye needs surgery. Many people are managed with medical therapy and observation, and decompression is reserved for selected situations.
Thyroid eye disease and other indications
Thyroid eye disease is the most common reason for orbital decompression. In this condition, an immune process enlarges the muscles and fat behind the eye, pushing it forward. Surgery is often considered once the active, inflammatory phase has settled, unless the optic nerve is threatened and earlier decompression is needed.
Other reasons can include tumors of the orbit, certain infections that crowd the eye, and trauma. The cause influences the route, the extent of bone or fat removal, and whether other specialists are involved.
Considering orbital decompression? The next step is a quiet, unhurried conversation.
Ophthalmic evaluation
Because decompression directly affects the eye, evaluation is shared with ophthalmology. Assessment may include measurement of how far the eye protrudes, tests of vision and color vision, evaluation of eye movement and double vision, and an examination of the eye surface and optic nerve.
Imaging with CT or MRI shows the orbit, the sinuses, and the relationship to the optic nerve, and helps plan which walls of the orbit can be safely opened.
Endonasal, external and combined routes
Decompression can be approached through the nose (endonasal), through small external or eyelid incisions, or through a combination, depending on which orbital walls need to be addressed. An endoscopic endonasal route can remove the medial (inner) wall and floor of the orbit without an external scar.
In some cases, fat is removed in addition to bone. The route is chosen to address the specific area of crowding while protecting the optic nerve, the eye muscles, and nearby structures.
Double-vision and vision-risk counseling
An important part of counseling is that decompression can change eye position and alignment. New or changed double vision (diplopia) can occur after surgery and sometimes requires additional treatment, such as prisms or eye-muscle surgery, later on.
As with any surgery near the eye, there are uncommon but serious risks to vision. These risks, along with the realistic goals of surgery, are discussed in detail before proceeding so that expectations are clear.
Considering orbital decompression? The next step is a quiet, unhurried conversation.
Postoperative eye and nasal follow-up
After surgery, the eye position, vision, and eye movement are monitored closely. When an endonasal route is used, nasal care and saline rinses support healing, and crusting is common for a period.
Follow-up is coordinated between the surgical team and ophthalmology so that any change in vision or alignment is addressed promptly. Further treatment for double vision or eyelid position is sometimes planned as a later, separate step.
Clinical references
Medical review
This page is a patient-education resource reviewed by the responsible Norelle Health clinician before publication. It does not replace an in-person evaluation. Sudden loss of vision, rapidly worsening vision, severe eye pain, or a rapidly bulging eye should be treated as an emergency, and you should seek immediate medical care.
Considering orbital decompression? The next step is a quiet, unhurried conversation.
Candidacy & Evaluation
Recovery & Aftercare
Specialists who perform orbital decompression
Dr. Adrian Ong
MD
Board-Certified Facial Plastic & Reconstructive and Head & Neck Surgeon
Dr. Adrian Ong is a board-certified surgeon who practices exclusively on the face, head, and neck, with expertise spanning rhinoplasty, sinus surgery, facial trauma, reconstruction, and sleep surgery.
- Functional and aesthetic rhinoplasty (including revision)
- Sinus surgery and complex revision sinus surgery
- Facial trauma and nasal fractures
- Head and neck cancer surgery and microvascular reconstruction
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