Purpose To determine the biometric and refractive changes after orbital decompression in Korean patients with thyroid-associated orbitopathy (TAO). Methods Retrospective, observational study (between October 2012 and September 2014) was performed. Patients with TAO undergoing orbital decompression for stable proptosis received ophthalmic examinations, including Hertel exophthalmometry, A-scan biometry, autorefraction measures, corneal topography, and wavefront aberration measures, before orbital decompression and again 2 months after surgery. Results Included in the study were 43 eyes from 23 patients. The mean exophthalmometric value decreased by 4.1 mm 2 months after orbital decompression (Po0.001). On average, axial length (AL) increased significantly by 0.08 mm (Po0.001); specifically, 37 (86%) of the 43 eyes had increased AL. Whereas anterior chamber depth and lens thickness showed no significant changes (P = 0.086 and P = 0.905, respectively), the mean spherical refraction and spherical equivalent (SE) decreased by 0.35 and 0.48 D, respectively (P = 0.008 and Po0.001, respectively). However, cylindrical refraction and axis showed no significant changes (P = 0.057 and P = 0.218, respectively). The changes in AL and SE were significantly correlated (R = − 0.411, P = 0.009). Notably, there were no changes in corneal topography or wavefront aberration after orbital decompression. Conclusions TAO patients who underwent orbital decompression showed myopic refractive change via increase in AL. Possible refractive changes should be considered in cases of TAO complaining of decreased visual acuity after orbital decompression.