Most traumatic optic neuropathies are indirect, due to an impact on the head, especially on the forehead including the brow arch and frontal sinus area, where the impact is transmitted to the optic nerve canal and damages the optic nerve. According to our data: traffic accidents, especially motorcycle accidents, are the main cause of indirect traumatic optic neuropathy. The clinical course consists mainly of immediate and permanent loss of vision after injury of varying degrees, late exacerbation and spontaneous recovery. However, there is no technique of that kind that has predictive value for this. Any cause of ischemia, compression, strain and mechanical damage to the optic nerve can cause blindness. The most important causes are compression of the peri-optic nerve tissue, infection, and increased local ischemic cerebrospinal fluid pressure, all of which can be caused by one cause or multiple causes at the same time. Diagnosis of traumatic optic neuropathy is not always straightforward and is related to the examination conditions. The diagnosis is confirmed by objective visualization of optic nerve damage, loss of direct pupillary response, or pathologic flash-evoked visual response. The diagnostic points of the disease are: (1) history of closed cranial trauma, especially with external forces from the frontal area and above the brow arch; (2) sharp reduction or loss of vision after the injury; (3) loss of direct pupillary response to light on the affected side and presence of indirect response to light; (4) positive findings on CT scan; and (5) assessment of the disease with optic nerve evoked potentials helps in the diagnosis. Transnasal endoscopic optic nerve decompression in patients with traumatic optic neuropathy is performed under general anesthesia. The CT data were carefully studied before surgery. First, the leptomeningeal and septal vesicles are removed, and the anterior and posterior septal and pterygoid sinuses are opened to confirm the septal apex, the papillary plate, the internal carotid artery bulge optic canal bulge, and its fracture line. The optic canal is ground open to expose the optic nerve sufficiently, and the epiretinal membrane of the optic nerve is dissected. The common tendon ring is also dissected together. The operative cavity is filled with gelatin sponge. Patients who undergo surgery within one week of injury have better outcomes than those who undergo surgery more than one week later. The main reason for this is that the longer the nerve has been ischemic and compressed, the less likely it is to recover. In addition to the time to be operated, other factors that affect the outcome are the severity of the optic nerve injury and the time of onset of visual impairment. The absence of light perception immediately after injury suggests direct compression and cutting of the optic nerve by the bone fragment, whose injury is primary. Delayed loss or loss of vision is due to local ischemia and either elevated cerebrospinal fluid pressure or a gradual increase in peri-optic nerve pressure. The former is significantly less effective than the latter. Treatment-failed indirect optic neuropathy is characterized by patients with no light perception, no response to hormones, immediate post-injury loss of vision and surgery long after the injury. Raw visual acuity is a key factor in the prognosis of indirect optic neuropathy. Surgical optic nerve decompression may also be considered in patients with maxillofacial trauma with no light perception of visual acuity. The surgical guidelines for transnasal endoscopic optic nerve decompression have been relaxed because of the many advantages over the conventional procedure. Absence of postoperative light perception but response to hormones and delayed visual impairment are not absolute contraindications to transnasal endoscopic optic nerve decompression. Patients with immediate post-injury aphakia and non-response to hormones have little surgical significance. However, strict indications for transnasal endoscopic optic nerve decompression contribute to increased efficiency.