In a few patients with Graves' disease, visual loss related to an optic neuropathy develops. Clinical and radiologic evidence suggests that the mechanism of visual loss is optic nerve compression in the orbital apex. Steroids may offer improvement, but often the condition recurs unless high doses are maintained. Orbital decompression provides dramatic visual and cosmetic improvement in most cases. A transorbital approach suitable to the experienced orbital surgeon for decompression of the orbital floor and medial wall has been presented in a companion article. Results of this approach in 12 eyes with visual loss unmanageable by steroid therapy indicate a gratifying improvement in vision. Strabismus is the most frequent complication. Results with follow-up ranging from six to 18 months are encouraging and comparable to the results obtained with other methods of surgical decompression.