Purpose of Review <p>The purpose of this review is to summarize the literature surrounding endoscopic orbital decompression, and providing an overview of indications, operative steps, and alternatives.</p> Recent Findings <p>Endoscopic orbital decompression can be used for indications ranging from thyroid eye disease to infection, tumors, and trauma. The literature shows postoperative improvement in proptosis and visual function for medial, inferior, and combined orbital decompression. Decompression can achieve average proptosis reductions of 3.5–4&#xa0;mm. Preservation of the inferomedial orbital strut and periorbital sling can lower the risk of postoperative diplopia.</p> Summary <p>Personalized approaches for endoscopic orbital decompression can be tailored to each patient depending on the indication and extent of surgery with reduced adverse effects compared to open approaches.</p>