Thyroid related orbitopathy (TRO) is the most common orbital disease in adults and has been reported for more than 200 years since its first report. However, its pathogenesis is not yet fully understood, so clinical treatment is still limited to symptomatic treatment, which mainly includes hormonal, radiological and surgical treatments. When the development of the disease causes compressive optic neuropathy resulting in vision loss, visual field damage or corneal exposure and conservative treatment is ineffective, orbital decompression is required to protect the optic nerve and cornea and maintain monocular vision in both eyes. In recent years, the number of patients undergoing orbital decompression surgery to restore eye aesthetics has also gradually increased, accounting for approximately 40% of patients. Orbital decompression surgery has evolved over a century with numerous procedures. However, as a destructive surgical procedure, it is a new proposition in modern orbital surgery to obtain effective orbital decompression in the most precise and safe manner with minimal trauma. The choice of surgical approach and problems of traditional orbital decompression surgery Since 1911, when Dollinger reported orbital decompression by lateral orbital wall dissection in patients with TRO, five different surgical approaches have been established and improved: the lateral approach (Kr?nlein), the trans-sinus approach (Ogura), the approach into the frontal bone (Naffziger), the septal approach ( Sewall), and maxillary approach (Hirsch). Most ophthalmic surgeons currently use a modified Ogura orbital decompression, in which the orbital contents are decompressed into the maxillary and septal sinuses. However, resection of the inner and lower orbital wall can cause complications such as change in eye position and limited eye movement. Later, Shepard et al. proposed the concept of balanced orbital decompression, in which the outer orbital wall is combined with the inner wall decompression to reduce the displacement of orbital contents caused by inferior wall decompression or single wall decompression, and to reduce postoperative hypotony and diplopia [1]. The preservation of the bony connection between the septal and maxillary sinuses can help avoid downward displacement of the eye and reduce the occurrence of diplopia [2]. The ophthalmology department of the Ninth People’s Hospital of Shanghai Jiaotong University School of Medicine performed intra-orbital and inferior wall decompression in 16 patients (23 eyes) with TRO, and two patients (4 eyes) with internal, inferior, and external wall decompression, all of which preserved the bony “strut” structure between the intra-orbital and inferior walls (Figure 1). At 6-month follow-up, the prominence of the eye was reduced by 7.3±2.1 mm after triple wall decompression and 3.8±0.6 mm after double wall decompression compared with the preoperative period; the eye movement improved in 15 of these eyes; diplopia improved in 6 patients, and no patient had worsening diplopia after surgery. The choice of orbital decompression surgery was based on the prominence of the patient’s eye and the status of visual function. A proper surgical approach and timing can bring the patient the ideal result of retrobulbar regression. In the literature, it has been reported that one-wall orbital decompression can result in 2-3 mm of retroversion, two-wall orbital decompression can result in 4-6 mm of retroversion, three-wall orbital decompression can result in 7-10 mm of retroversion, and four-wall orbital decompression can result in 10-17 mm of retroversion [3]. However, as the surgical goal of ideal correction of orbital protrusion was achieved, attention was paid to the complications associated with orbital decompression surgery: (i) functional: displacement of the eye, diplopia, blindness, tear duct obstruction, and cerebrospinal fluid leakage; and (ii) cosmetic: asymmetry of bilateral protrusion, surgical scars, and inversion and ectropion of the eyelids. It is because of these complications that often the prominence of the eye is corrected after surgery, but still no satisfactory clinical results can be obtained. To solve the above problems, the endocrine adjustment of thyroid function is relatively stable and the inflammatory situation is under some control. President Fan Xianqun and Director Zhou Huifang of the Jiu Hospital Ophthalmology Department have the best technology in the country in this regard: (1) minimally invasive, including surgical incision design and intraoperative operation; (2) precise design of the orbital decompression site and range, and prediction of orbital volume changes and postoperative eye position; (3) intraoperative visualization operation, with precise control of (3) Intraoperative visualization, precise control of the scope of decompression, and avoidance of important intraorbital structures. In recent years, with the development of craniofacial and digital surgical techniques, endoscopic and navigation techniques have been introduced into orbital surgery and have been successfully applied in orbital fracture repair and reconstruction, expanding the indications for surgery while reducing the risk of treatment. Of course, orbital decompression is an operation that destroys the normal orbit and therefore differs from orbital reconstruction in many ways. The research on orbital decompression digital surgery is in its infancy at home and abroad and is both a hot spot and a difficult area of research.