I am having OD on Tuesday, and once I am able, I plan to update here regularly on my progress. I'll answer your questions the way my surgeons have answered them for me, but everyone differs. Keep in mind I am having an oculofacial surgeon (the one who usually does ODs) as well as an ENT surgeon who will go up my nose to remove the bone between each eye and my nose, as well as possibly the bones beneath each eye. The oculofacial surgeon will enter from my non-exists crow's feet to remove the bone from the outer side of each eye. My TED is only moderate on the ophthalmology scale, but because I had very narrow, deep-set eyes before TED, my surgery is considered major. Because of that…
1. The more bone they remove (some people only need a fat decompression), the higher chance of double vision, which I do not currently have nor have I ever had. My personal risk is 50/50, but the strabismus surgery is considered very minor and straightforward. The only drawback is that if I do develop double vision, I have to wait three months for my eyes to completely heal before I can have the strabismus surgery. I don't know what you mean by looking worse, but OD isn't a perfect fix for most. Most people need an additional surgery to lower their upper eyelids, which remain retracted after OD. I WILL need these, so I am either facing two or three surgeries.
2. The dryness should be mostly relieved because your eyes will close completely and not be so exposed when open, but if you rush into OD before your eyes are done changing and the TED is still active, the OD will be useless and you may need an additional one. That's why most ophthalmologists/surgeons require us to wait at least one year after symptoms cease before operating.
3. The OD will not improve vision. If you need glasses or contacts now (I do), you will still need them afterward. They don't operate on your eyeballs at all, just the bone and fat around your eyes. I was told I couldn't wear contacts for three weeks after surgery. I hate how I look in glasses, but it'll probably help cover up some of the bruising and swelling.
4. My insurance will process each surgery as a separate claim. I'd be happy to share, in very general terms, how they process the claims for the OD itself. Since I have two surgeons, I'm not sure how that works but my claims are usually online within a few days, so I will check late next week. My surgery is being done in the outpatient/day surgery department of the hospital, but even if I am admitted for complications, there is absolutely zero cost to me (I've already met my $2,000 deductible for the year… which started July 1!) because I have no co-pay or co-insurance for surgery, inpatient or outpatient.
What's the current state of your TED? If you'd like, I can PM you my personal blog, where I am documenting my life - which obviously includes Graves and TED as well as all other goings-on.