Objective To investigate the clinical efficacy and prognostic factors of transnasal endoscopic optic nerve decompression in the treatment of traumatic optic neuropathy (TON). Methods Retrospective analysis was performed on 21 TON patients in Longgang Otolaryngology Hospital of Shenzhen City from 2015 to 2018.And these patients had received neural tube decompression via nasal endoscopy after high-dose hormone therapy failed. The improvement of visual acuity was used as the criterion to judge the clinical efficacy. Results Postoperative with the treatments of routine antibiotics to prevent infection, hormones, improve circulation, nutrition and other drug, all patients were followed up for 6 months.There were 6 cases of postoperative effective for 14 cases of preoperative no light, and the effective rate was 42.9%; Seven cases with residual light sensation before operation, 5 cases of them had effective after operation, and the effective rate was 71.4%. The 13 cases operated within 7 days after injury, 9 cases of them were effective, and the effective rate was 69.2%. Injuries of 8 cases were operated after 7 days,2 cases of them were effective, and an effective rate was 25.0%. Conclusions Transnasal endoscopic optic nerve decompression is an effective way for the treatment of TON. The presence of residual light perception and the timing of surgery within 7 days are critical to the prognosis.