Orbital decompression is commonly performed for thyroid eye diseaseThyroid eye disease but is also used in other space occupying orbital diseases. Most orbital decompressions are customized with various extent of the orbit floor, medial wall, or the lateral wall removed. In this chapter, the author outlines an orbit decompressionOrbit decompression protocol that begins with floor and medial wall decompression using direct surgical landmarks. Lateral wall decompression is also described as the third orbital wall decompressed in more severe orbitopathy.