Endoscopic optic nerve decompression is a safe and reliable approach for surgical decompression. However, the indications and efficacy of surgical decompression remain debatable. Surgical decompression may be performed for numerous lesions that compress the optic nerve in the optic canal leading to problems with vision. However, it is most often most controversially employed for decompression in indirect traumatic injuries to the optic nerve. Advances in endoscopic instrumentation and surgical techniques have made endoscopic optic nerve decompression via an intranasal transethmoidal-transsphenoidal a preferred approach over other extracranial or craniotomy approaches.