Objective:To explore the advantages of different surgical paths of nasal endoscopy for different naso-ophthalmic diseases with eye as the first symptom and analyze the efficacy..Method:The clinical data of 48 nasal and eye-related cases with ocular symptoms as the first symptom admitted to our department from January 2020 to July 2022 were retrospectively analyzed.According to the different site, type and scope of the lesion, five different surgical paths were used for treatment:Thirty-nine cases underwent classical Messeerklinger surgical path under nasal endoscopy, 3 cases underwent anterior lacrimal recess path under nasal endoscopy, 3 cases underwent enlarged lateral nasal wall resection path under nasal endoscopy, 2 cases underwent combined eyebrow arch path under nasal endoscopy, and 1 case underwent combined labial-gingival crevicular path under nasal endoscopy.To evaluate the advantages and efficacy of different surgical paths under nasal endoscopy.Result:48 patients were followed up for at least 3 months,Among them, 5 cases underwent endoscopic Messeerklinger surgical path of optic canal decompression, 3 cases recovered from preoperative no light sensation to postoperative index/20cm, 1 case recovered from preoperative 0.1 to postoperative 0.4, and 1 case did not improve significantly.The eye symptoms of the remaining 43 patients were completely eliminated, without diplopia and strabismus, vision loss, dry eyes, tears, eyeballs, redness and swelling, cerebrospinal fluid rhinorrhea, facial numbness, pain and other clinical symptoms, and postoperative nasal ventilation was good.Conclusion:According to the different types, scopes and imaging characteristics of the naso-eye related lesions with the eyes as the first symptom, different surgical paths under nasal endoscopy are selected, which has short operation time, fewer postoperative complications, fast recovery and satisfactory curative effect.