Objective To explore the advantages of different endoscopic surgical approaches for different nose-eye related diseases with initial ocular symptoms and analyze the curative efficacy.Methods Clinical data of 48 patients suffering from nose-eye related diseases with initial ocular symptoms admitted to our department from January 2020 to July 2022 were retrospectively analyzed. According to the location, type and scope of the lesion, five different surgical approaches were used for the treatment. Under nasal endoscopy, the classical Messeerklinger approach was selected in 39 cases, the anterior lacrimal recess approach in 3 cases, the expanded lateral nasal wall resection approach in 3 cases, the combined eyebrow arch approach in 2 cases, and the combined labio-gingival sulci approach in one. The advantages and efficacy of different surgical approaches under nasal endoscopy were evaluated.Results All the 48 patients were followed up for at least 3 months. Among them, in 5 cases underwent optic canal decompression via endoscopic Messeerklinger approach, 3 recovered from preoperative no light sensation to postoperative index /20 cm, 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 clinical symptoms such as diplopia, vision loss, dry eyes, tears, exophthalmos, redness and swelling, cerebrospinal fluid rhinorrhea, facial numbness, pain, etc. Nasal ventilation was good after surgery.Conclusion According to the different types, scopes and imaging characteristics of the nose-eye related lesions with initial ocular symptoms, different endoscopic surgical approaches are selected with advantages of short operation time, fewer postoperative complications, fast recovery and satisfactory curative effect.