In recent years, with the development of transportation and the increase of people’s outdoor activities, the traumatic optic nerve injury is increasing year by year. Compared with the traditional transcranial surgery, because the lateral wall of the pterygoid sinus is the medial wall of the optic nerve canal, the transnasal endoscopic optic nerve decompression surgery has the advantages of direct pathway, minimally invasive, small collateral injuries, thorough decompression, accurate localization and so on, and it has gradually become the first choice of optic nerve decompression surgery. The sooner the optic nerve decompression is done, the better, preferably within three days, but we also have more than 20 days surgery to restore vision. Generally, the results are better if there is a change in vision after the injury, and worse if there is no light sensation immediately after the injury.