Objective: To explore the relationship between smoking and the onset, progression, treatment and prognosis of Graves' ophthalmopathy (GO), so as to provide a basis for the clinical prevention and control of GO. Methods: Recent domestic and foreign literature regarding smoking and GO was searched to sort out its related mechanisms and clinical impacts. Results: Smoking is a vital environmental risk factor for GO. It induces the occurrence and progression of GO via multiple pathways and affects treatment efficacy and prognosis. Smoking cessation can effectively prevent GO and improve therapeutic efficacy and prognosis. Conclusion: Smoking adversely affects the disease course and therapeutic efficacy of GO. Smoking cessation should be included in the routine strategies for prevention and clinical management of GO.