Abstract: Traumatic optic neuropathy (TON) is caused by craniofacial trauma leading to optic nerve damage, characterized by a sudden and significant decrease in vision or complete blindness. Clinical interventions for TON include simple observation, corticosteroid therapy, and optic nerve decompression. However, there is controversy over which treatment method is optimal. With advancements in endoscopic techniques, endoscopic transnasal optic nerve decompression (ETOND) has increasingly become a mainstream method for treating TON. Despite this, there is a lack of high-quality randomized controlled trials to evaluate its efficacy. Furthermore, treatment outcomes are influenced by several factors, including the timing of surgery, the severity of vision loss, optic canal fractures, optic nerve sheath incision, and hemorrhage within the ethmoid and/or sphenoid sinuses. This review provides an overview of the recent clinical efficacy, prognostic factors, and technological innovations in ETOND for the treatment of TON.