Orbitopathy associated with Graves disease may severely compromise a patient's vision. The condition may cause diplopia, decreased ocular motility, exposure keratitis, optic neuropathy, and poor cosmesis. Surgical management is both an alternative and adjunctive treatment to medical therapy, which most often involves corticosteroids, external beam radiotherapy, or both. Orbital decompression most often involves the removal of the bones that comprise the orbit. Decompression of a lesser nature can be accomplished with the removal of extraconal and intraconal fat. This fat decompression can be combined with bone removal for more extensive decompression.

Various surgical approaches can be used for decompression. Ultimately, the approach or approaches used are tailored to the severity of the problem and therefore the degree of decompression desired and the anatomy of the patient. These decisions can be influenced by the cosmesis achieved, especially in patients who are undergoing decompressions to improve their appearance.