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To evaluate the utility of transconjunctival fat removal combined with conservative (“strut-sparing”) bony medial/floor orbital decompression for Graves orbitopathy.Retrospective, noncomparative case series of 52 orbits in 28 patients that underwent decompression using this technique. Preoperative and postoperative exophthalmos, diplopia, logMAR visual acuity, and orbital symmetry were measured.Reduction in exophthalmos up to 8 mm with a mean of 3.3 mm (±1.5 mm) was achieved for decompressed orbits (p < 0.001). Postoperative symmetry within 2 mm was achieved in all patients. Diplopia was improved in 4 patients (14%), unchanged in 23 (82%), and worse in 1 (4%). Mean logMAR visual acuity improved −0.11 units (p = 0.007).Orbital fat removal combined with conservative (“strut-sparing”) bony medial/floor orbital decompression via a single transconjunctival incision is an effective and efficient technique with minimal morbidity.