To evaluate the change in the intraocular pressure (IOP) in subjects with Graves orbitopathy (GO) after orbital decompression (OD) with glucocorticoids (GCs).Ninety-nine orbits of 76 patients with GO were retrospectively reviewed, with either OD (Group A), OD with intravenous glucocorticoids (i.v.GC) (Group B) or parabulbar GC (Group C) administration. The main outcome measures included pre-and post-operative IOP in the primary and upward gazes.Mean postoperative IOPs in the primary gaze were lower than the preoperative values for groups A and C (P < 0.05). The IOPs during the upward gaze were higher than those in the primary gaze before and after OD (all groups, P < 0.05). The mean postoperative and preoperative IOPs during upward gaze were similar in all groups except group C (P = 0.001). The mean decrease in IOP in the primary gaze was 1.57 ± 6.00 mm Hg and 2.22 ± 2.62 mm Hg in groups A and C, respectively (P < 0.05). Only in group C, the mean IOPs during upward gaze decrease by 5.29 ± 4.89 mm Hg (active GO before OD), and the mean gaze-related IOP decreased from 7.75 ± 6.02 to 2.57 ± 4.21 mm Hg (P < 0.05).A pbGC treatment before OD can effectively reduce the primary and upward gaze IOPs and lead to a greater postoperative reduction in the upward gaze IOP to approximate that in the primary gaze. A pbGC treatment may be preferred for patients with GO in the active or congestive phase before OD considering the IOP.Copyright © 2024 by Mutaz B. Habal, MD.