Orbital decompression enlarges the bony eye socket to make room for the swollen muscles and fat of thyroid eye disease. It is the definitive surgical treatment for fibrotic-stage proptosis and the urgent, sight-saving intervention when an enlarged orbit compresses the optic nerve. Our consultant oculoplastic and orbital team offers balanced two-wall, endoscopic medial and three-wall decompression, and delivers all three stages of the rehabilitative pathway under one roof.
What orbital decompression treats
Thyroid eye disease (Graves’ orbitopathy) inflames and enlarges the extraocular muscles and orbital fat. Trapped inside a fixed bony orbit, that extra volume pushes the eye forward (proptosis), exposes the cornea, and — at its most dangerous — crowds the optic nerve at the orbital apex. Orbital decompression removes one, two or three bony walls (and sometimes fat) to create space, relieving pressure and returning the eye toward its natural position.
Surgery is reserved for the fibrotic, burnt-out phase of disabling proptosis, severe exposure keratopathy or chronic globe subluxation — and is performed urgently, regardless of disease phase, for sight-threatening dysthyroid optic neuropathy. Active inflammatory-phase disease without optic-nerve threat is treated medically first.
Surgical approaches
The approach is tailored to the indication, the degree of proptosis and whether the optic nerve is threatened. Your consultant calibrates the plan against your Hertel exophthalmometer reading and orbital CT.
How the procedure works
Decompression is performed under general anaesthesia as an inpatient. For rehabilitative cases, the surgeon works through hidden incisions — a transcaruncular route for the medial wall and an upper-lid-crease or lateral-canthal route for the lateral wall — so there is no visible facial scar. Bone is removed to open the orbit into the adjacent ethmoid sinus and lateral orbital region; the lateral wall may be reconstructed with a prosthetic plate where appropriate, and intraconal fat is selectively removed in three-wall cases.
For sight-threatening dysthyroid optic neuropathy the priority is the orbital apex: an endoscopic transethmoidal medial wall and apical decompression relieves the compressed optic nerve directly. Wounds are closed with absorbable sutures.
Worried about proptosis, exposure or failing vision? A consultant can stage your care and advise on timing.
Book your assessmentRecovery & the staged pathway
Days 0–2 — Inpatient observation
A 1–2 night stay with hourly checks of vision, pupils and orbital pressure to detect the very rare retrobulbar haematoma early. Bruising and lid swelling peak now.
Weeks 1–2 — Early healing
Swelling and bruising settle steadily. Most patients return to non-strenuous office work in weeks 2–3, and air travel is permitted from week 2–3.
Weeks 4–6 — Return to activity
Strenuous exercise, contact sport and heavy lifting resume, guided by your healing at the week-6 consultant review.
Months 6–12 — Staged rehabilitation
If decompression leaves any new double vision, adult squint surgery is performed at 6–12 months, followed by eyelid surgery for retraction or lid appearance as stage three.
Cost of private orbital decompression
UK 2026 self-pay pricing is £7,500–12,000 unilateral, £12,000–18,000 for bilateral two-wall and £15,000–22,000 for bilateral three-wall with fat removal. Quotes are all-inclusive of consultant assessment, multidisciplinary endocrine and skull-base planning, orbital CT and MRI, anaesthetic and theatre fees, any prosthetic implants, the 1–2 night inpatient stay and a 12-month staged follow-up programme. Strabismus and eyelid stages, when needed, are quoted separately. See the oculoplastic price guide for a full breakdown.
Frequently asked questions
Self-pay orbital decompression in the UK in 2026 is typically £7,500–12,000 unilateral, £12,000–18,000 for bilateral two-wall and £15,000–22,000 for bilateral three-wall with fat removal. Fees are all-inclusive of consultant assessment, multidisciplinary planning, orbital CT and MRI, anaesthetic and theatre fees, the 1–2 night inpatient stay and a 12-month follow-up programme.
Sight-threatening dysthyroid optic neuropathy — where enlarged extraocular muscles compress the optic nerve at the orbital apex and acuity, colour vision or visual field is dropping — is a sight-saving emergency. If high-dose intravenous steroids fail to restore function, urgent endoscopic medial wall and apical decompression is performed within days.
A balanced two-wall (medial + lateral) decompression typically reduces proptosis by about 3–5 mm per side, while a three-wall decompression with selective fat removal can achieve 5–7 mm or more. The target is calibrated at planning against your Hertel exophthalmometer reading and orbital CT.
New or worsened double vision is the most significant late effect, reported in roughly 15–30 percent of cases. Modern balanced two-wall (medial + lateral) decompression has lower rates than older isolated inferomedial approaches, and any new diplopia is corrected within the staged pathway with adult squint surgery at 6–12 months.
Often, yes. Decompression is stage one of the established three-stage rehabilitative sequence for thyroid eye disease: decompression first, then strabismus (squint) surgery for any double vision, then eyelid surgery for retraction or lid appearance. All three stages are offered in-house.
Teprotumumab is an IGF-1 receptor antibody that can reduce proptosis and double vision during the active inflammatory phase. Orbital decompression is the surgical answer in the fibrotic stage and the urgent treatment for sight-threatening optic neuropathy. They target different phases of the same disease and are complementary — many patients have medical therapy first and decompression later if proptosis remains disabling.