Orbital Decompression in NYC

Restoring Comfort, Vision, and Natural Contour

Orbital decompression is a delicate surgical procedure that relieves pressure within the eye socket (orbit) caused by thyroid eye disease (TED), Graves’ orbitopathy, or trauma-related conditions. The goal is to create more space within the orbit by removing bone and/or fat, allowing the eye to settle back into a more natural position—improving both function and appearance.

Dr. Robert Schwarcz, a double board certified oculofacial plastic and reconstructive surgeon in NYC, is a leading expert in orbital decompression. With over 20 years of experience, he approaches each case with the precision of a reconstructive specialist and the eye of a cosmetic surgeon, ensuring optimal outcomes for both medical and aesthetic concerns.

What Is Orbital Decompression?

Orbital decompression is a surgical procedure that involves removing or thinning the bony walls of the eye socket and, in some cases, removing orbital fat. This reduces pressure behind the eyes and helps reposition the eyes if they are bulging (proptosis) due to inflammation, swelling, or excess tissue growth.

It is most commonly performed for patients with:

• Thyroid Eye Disease (TED) or Graves’ Orbitopathy, where autoimmune activity causes inflammation, pushing the eye forward

• Orbital tumors or cysts

• Traumatic injury that increases orbital pressure

• Vision-threatening optic nerve compression

Dr. Schwarcz works alongside a bone specialist for these complex cases, and surgeries typically take place in a hospital setting for maximum safety.

Who’s a Good Candidate?

You may be an ideal candidate for orbital decompression if:

• You have bulging or protruding eyes due to thyroid eye disease or orbital mass

• You are experiencing eye pain, pressure, or double vision

• You have vision loss or optic nerve compression

• You feel self-conscious or uncomfortable due to eye protrusion

• You are in good overall health and cleared for general anesthesia

If both eyes are affected, Dr. Schwarcz typically recommends operating on one eye at a time, with a recovery period of several weeks between procedures to monitor healing and visual changes.

When It Might Not Be Right for You

Orbital decompression may not be suitable if:

• Your thyroid eye disease is in an active, inflamed phase—surgery is often best done once inflammation has stabilized

• You have severe medical conditions that make surgery risky

• You are looking for purely cosmetic improvement without any functional concern

Dr. Schwarcz will assess your condition with imaging and a full eye exam before recommending a surgical plan.

Preparing for Surgery

Preparation for orbital decompression is comprehensive and carefully coordinated:

• Medical Clearance: You may need lab work, imaging (CT or MRI), and a full ocular exam to assess optic nerve function and orbital anatomy.

• Medication Review: Avoid blood thinners, aspirin, and certain supplements at least two weeks before surgery.

• Smoking Cessation: If you smoke, quitting will significantly improve healing and reduce complications.

• Arrange Support: Plan for someone to accompany you and help in the first few days post-surgery.

Dr. Schwarcz and his surgical team will provide detailed pre-op instructions tailored to your specific case.

What to Expect During Surgery

Orbital decompression is performed under general anesthesia in a hospital setting. Depending on your case, the procedure may involve:

• Fat Decompression: Removing some of the orbital fat to reduce pressure.

• Bony Decompression: Removing portions of the orbital walls (medial, lateral, or floor) to expand the space for the eye and surrounding tissues.

• Combination Technique: In most cases, both bone and fat decompression are used for optimal results.

The surgery typically lasts 1.5 to 3 hours, and you’ll be monitored in recovery before going home or staying overnight, depending on your health and comfort.

Recovery & Healing

Recovery from orbital decompression varies depending on the extent of the surgery and whether one or both eyes are treated.

• First 3–5 Days: Expect swelling, bruising, and soreness around the eyes and cheeks. Ice packs and pain medication will help.

• 1–2 Weeks: Swelling and bruising subside. You may have mild double vision, which often resolves as swelling decreases.

• 2–6 Weeks: You’ll begin to see improvement in eye position, comfort, and pressure.

• If Both Eyes Are Treated: The second eye is typically scheduled 4–6 weeks after the first, once healing has progressed.

Follow-up visits are crucial to monitor vision, eye movement, and cosmetic symmetry. Dr. Schwarcz’s approach ensures both safety and natural contour restoration.

Results

Orbital decompression can significantly improve:

• Bulging/protruding eyes, restoring a more natural, rested look

• Eye pressure, pain, and dryness

• Visual symptoms, including double vision and optic nerve compression

• Facial symmetry, particularly in cases of trauma or severe proptosis

Scars are typically hidden inside the eyelid or in natural creases, and Dr. Schwarcz’s surgical finesse means minimal visible signs of surgery once healing is complete.

Complementary Treatments

Depending on your condition and cosmetic goals, Dr. Schwarcz may recommend additional procedures after orbital decompression, including:

• Eyelid Surgery (Blepharoplasty) – To correct lid retraction or contour irregularities

• Strabismus Surgery – To realign the eyes if double vision persists

• Fat Grafting or Fillers – To improve periorbital volume and symmetry

• CO2 Laser Resurfacing – To refine skin texture and reduce fine lines around the eyes

These may be staged several months after healing from your decompression.

Alternatives

If you are not ready for surgery or if your eye protrusion is mild, alternatives may include:

• Topical Lubricants & Eye Drops – To relieve discomfort

• Prism Glasses – For double vision

• Steroid Therapy or Immunosuppressants – In active phases of thyroid eye disease

• Teprotumumab (Tepezza) – A relatively new FDA-approved medication for TED, which may reduce proptosis in some patients

Dr. Schwarcz will discuss all options and help you choose the right path based on your medical and cosmetic needs.

Why Choose Dr. Robert Schwarcz?

Orbital decompression requires an extraordinary level of expertise in both form and function. As a double board certified oculofacial plastic and reconstructive surgeon, Dr. Schwarcz combines deep anatomical knowledge with advanced surgical techniques to deliver results that restore vision, eye comfort, and facial harmony.

Every step—from imaging to surgery to post-op care—is handled with precision and compassion.

Struggling with eye pressure or bulging due to thyroid eye disease or trauma? Click the Request an Appointment button below to schedule a consultation with Dr. Robert Schwarcz and take the first step toward restored comfort, vision, and natural appearance.