In general, TED-related vertical deviations require' bilateral or unilateral IR recession with or without contralateral superior rectus recession to restore binocular single vision.[47] Finally, IR muscle recession can cause lower eyelid retraction, especially when recession is >4 mm. Orbital decompression, followed by strabismus surgery, followed by eyelid surgery, is the accepted sequence of surgical intervention, as each step may affect the next.[1] Orbital Decompression Indications, Preoperative Considerations Orbital decompression is nuanced and must be tailored to each patient. In that case, decompression surgery could improve the lower eyelid position by reducing axial proptosis and sometimes reducing or even eliminating lower lid retraction without additional surgery.[94] Cho et al[95] investigated the effect of orbital decompression surgery on lid retraction as a function of proptosis reduction. Lockwood's ligament advancement and release of lower eyelid retractors may prevent lower eyelid retraction postoperatively.[63] Graph: Figure 4 Repair of TED-induced right hypertropia with left inferior rectus recession with adjustable sutures. [Extracted from the article]