To address the problem of poor accuracy of transmission line tower construction tilt detection, a transmission line tower construction tilt detection method based on secondary point cloud matching is proposed. The point cloud data of the pole tower is obtained through the aerial survey of UAV, and the secondary point cloud matching method is designed. Firstly, the extended Gaussian image clustering algorithm is introduced to complete the coarse matching of the point cloud, and the improved iterative nearest method is used to carry out the fine matching of the point cloud, and the change amount of the pole tower tilt is calculated through the secondary point cloud matching results, and whether the pole tower has tilt problems is judged according to the change amount of tilt. The experimental results show that the point cloud matching accuracy of the method is better, the point cloud matching time is shorter, and the tilt of transmission line towers can be accurately detected.