Thyroid-associated ophthalmopathy is an autoimmune disease involving the orbital and extraocular muscles, and includes hyperthyroidism (hyperthyroidism) and partial normal or hypofunction. Hyperthyroidism is the most common form of proptosis. Patients may have mild eyelid swelling, conjunctival congestion, foreign body sensation, dryness, eyelid retraction or late drop; protruding eyeballs, ocular motility disorders, diplopia, and decreased visual acuity. Laboratory tests show normal or increased 131I uptake; normal or increased serum T3 and T4 levels; about 75% of T3 suppression tests are unsuppressed or partially suppressed. Hyperthyroidism proptosis not only affects visual acuity and function, but also affects cosmetic appearance, so it needs to be reasonably examined and treated. The goal of treatment is to relieve the increased intraorbital pressure and the protrusion of the eye, thus reducing diplopia and cosmetic changes and protecting visual function. Commonly used treatments for hyperthyroidism include glucocorticoid therapy, immunosuppressive therapy, growth hormone inhibitor therapy, immunoglobulin therapy, intraorbital radiation therapy and surgery. The specific treatment plan should be based on the severity of the patient’s condition, the activity of the disease, and the subjective wishes of the patient. Patients with moderate to severe disease, or those with rapid clinical progression, may be considered for surgical treatment. However, conservative treatment is usually an option for patients in the active phase. Surgery also becomes an option when the disease is too long, in the inactive phase, and when pharmacological treatment is not sufficiently effective. Especially in cases of ophthalmologic emergencies and rapid vision loss where medication does not work in time, surgery can provide rapid relief of IOP and its resulting ocular symptoms. The concept of orbital decompression was introduced as early as 1888. Orbital decompression it improves the symptoms of a protruding eye by removing the bony orbital wall, relieves pressure on the optic nerve, and provides a cosmetic effect at the same time. Theoretically, the four bony walls of the orbit can be surgically removed and decompressed. However, surgery on the superior and lateral walls of the orbit has major drawbacks. Surgery on the superior wall is highly traumatic and can easily cause intracranial hemorrhage, damage the frontal lobe, and lead to meningitis, while surgery on the lateral wall is not effective in decompressing the herniated eye. And because of the disadvantages of the surgical approach due to the presence of incision scars left on the face, large tissue trauma, narrow field of vision, poor illumination, and more complications, it has generally been rarely carried out clinically. The nasal sinuses and the orbit are adjacent to each other, so decompression of the orbital wall and inferior wall can be performed through the nasal sinuses, which is also a common clinical procedure. This procedure can reduce the protrusion of the eye by an average of 4.7 mm, which can effectively reduce the pressure at the orbital apex and relieve the symptoms of optic nerve compression without leaving a skin scar. Meanwhile, with the full development of nasal endoscopic technology in recent years, combined decompression of the lateral and inferior orbital walls can be performed under nasal endoscopy to better reduce the intraorbital pressure and relieve the proptosis and its effects. In patients with optic nerve compression, optic nerve decompression can be performed at the same time, thus preserving visual function. Moreover, the nasal endoscopic procedure can expose and protect important structures such as the sieve roof, orbital apex, and optic nerve canal, which has a better advantage in reducing surgical morbidity. On the other hand, the procedure is non-invasive to the face and does not leave scars, which makes it acceptable to most patients. Foreign professional journals have analyzed the motivation of patients to undergo transnasal endoscopic orbital decompression, and more than half of them want to improve their appearance through the procedure. Currently, transnasal endoscopic orbital decompression has been recognized by many doctors and patients abroad and is playing an increasingly important role in the treatment of hyperthyroidism. In conclusion, the surgical treatment of patients with hyperthyroidism proptosis should first be done at the right time and with adequate preoperative preparation in order to achieve better results.