Dr. Eli Chang discusses surgical options for thyroid eye disease cosmesis in a conversation with OphthalmologyWeb glaucoma editor, Dr. Brian Francis. Dr. Chang reviews his presentation, delivered at the 2008 World Ophthalmology Congress in Hong Kong, entitled “Decompression Surgery for Thyroid Eye Disease”. Over the past 20 years, the indications for this surgery have grown beyond globe subluxation, lagopthalmos, and compressive optic neuropathy (CON). Decompression is now frequently undertaken for rehabilitative and cosmetic reasons in the treatment of disfiguring exophthalmos. The more commonly used transcaruncular, endoscopic and transantral decompression procedures carry too great a risk of post-op diplopia -- nearly 38%. Dr. Chang describes a new decompression technique developed with Dr. Alfio Piva: “lateral wall with excision of greater sphenoid wing” (LW+GSW). Using an eyelid crease incision, this “ab externo” approach drills from the temporal fossa inward, vs. from the orbit outward in other procedures. Bone is removed following the temporal lobe dura into the greater sphenoid wing to the superior orbital fissure. The lateral wall is then removed from posterior to anterior. In the first series of 65 orbits, the incidence of postoperative diplopia was only 3%.