Orbital Decompression Alternatives? (photo)

Hello! I recently visited a plastic surgeon about the reduction in slight bulgyness of my eyes. About 5 years ago I underwent radiation iodine treatment and now my thyroid levels are regulated HOWEVER my eyes are still somewhat bulging and cause my eyelids to protrude to which isn't very attractive to me :( I understand orbital decompression is the big thing to fix it but I was wondering are there any less drastic procedures? Thank you!

Doctor Answers 3

Orbital Decompression alternatives for Thyroid Eye Condition

Orbital decompression, where the bone around the eye is removed, is generally the primary treatment for Graves eye disease. Orbital decompression is an outpatient procedure, similar to blepharoplasty or eyelid surgery, where patients go home the same day. Surgery can even be done through the nose without any external incisions! Patients typically return to work in a few days. A possible alternative to orbital decompression is to remove fat only, which sometime is required in addition to the bone decompression. Only after a comprehensive evaluation can a specialist help determine appropriate options for you. Best of luck.


Dr. Chaboki


Washington DC Facial Plastic Surgeon
4.9 out of 5 stars 85 reviews

Bulgy eyes (proptosis)

You do have asymmetric proptosis (bulgy eyes, aka proptosis).  You will benefit from one sided orbital decompression, which would be the best treatment for you in the long run.  The surgery is actually an outpatient operation, so you should not be afraid of it.  And not all orbital decompressions are the same; this can be achieved using small hidden incision on the eyelid.  [Other options are available but are not nearly as good as orbital decompression in your case.  Those include malar rim implant to bring out (or forward) the eyelid, eyelid retraction surgery, etc.]  See an oculoplastic surgeon.

Mehryar (Ray) Taban, MD, FACS
Beverly Hills Oculoplastic Surgeon
4.9 out of 5 stars 73 reviews

Camouflage Procedures and Orbital Decompression Options

There are actually two choices in restoring one’s appearance after having thyroid related immune Orbitopathy, Thyroiditis or even Graves disease.  One is called Orbital Decompression which physically expands the space or reduces the volume of fat behind the eye and may also be a combination of both depending on the situation. Another is doing some type of a camouflage procedure where the eyelids are operated to close the eyes a little bit so they don’t look very prominent.

Orbital decompression has essentially two types: One is called the Bony Orbital decompression where the surgeon removes parts of the bones that open up into the sinuses. This will allow the tissue behind the eyes to move back. Another is called Fat Orbital Decompression where the surgeon physically removes fat directly from behind the eye.

In your situation, you really have to face the risks and benefits of orbital decompression before you decide. In one of your photos of you looking straight, I noticed that the lower eyelid seem a little but low. So I suggest that we do a procedure where we physically and vertically lift the lower eyelid so that it covers a bit of the eyeball. That will create an illusion but it doesn’t in any way change the physical position of the eyeball.

I hope this information is helpful for you in pursuing further knowledge about your choices and thank you for your question.

Amiya Prasad, MD
New York Oculoplastic Surgeon
4.3 out of 5 stars 72 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.