This patient presented with severe thyroid eye disease and experienced profound eye bulging, redness, orbital pain and light sensitivity. She also sleeps with her eyes open but did not have double vision. The patient and Dr. Douglas customized a plan to include bilateral lateral and fat decompression to move the eyes back and reduce the white under her eyes. She achieved the goal of a 7mm reduction and did not require additional surgery. She did not experience any double vision or require other interventions.