[Objective] The Qinghai-Tibet Plateau, characterized by extensive permafrost coverage, has undergone significant environmental changes under global climate change. Surface water dynamics serve as sensitive indicators of permafrost degradation. This study investigates surface water changes over the past 30 years in a typical permafrost degradation area of the eastern Qinghai-Tibet Plateau, distinguishing variations between permafrost and seasonally frozen ground zones and analyzing their relationships with temperature and precipitation. [Methods] Landsat 5 and Landsat 8 satellite images from 1995 to 2024 (August data only) were processed using Google Earth Engine (GEE) to remove clouds and high-reflectance interference via median-pixel compositing. An empirical annual mean ground temperature model adjusted for slope and aspect was applied to classify permafrost and seasonally frozen ground zones. Surface water was identified using the Normalized Difference Water Index (NDWI) with an Otsu global-local thresholding method, further refined by slope and hillshade data derived from ASTER Global Digital Elevation Model (GDEM). Surface waters were categorized by area: ≤0.001 km², 0.001~0.01 km², 0.01~1 km², and 1~100 km². Monthly temperature and precipitation data from local meteorological stations were used for correlation analysis with water body metrics. [Results] Permafrost and seasonal frost zones constituted approximately 63% and 37% of the study area, respectively, with a classification accuracy of 88.1% confirmed by field surveys. Between 1995 and 2024, total water bodies increased by 40%, while total water area expanded by 29%. Small water bodies (≤0.01 km²) significantly contributed to quantity increases, whereas large water bodies (1~100 km²) dominated area expansion. Permafrost zones experienced an 85% rise in water body count, driven primarily by numerous small water bodies due to thaw-induced subsidence, but only a 28% increase in area. Seasonal frost zones showed a moderate 16% increase in count and a 28% increase in area, mainly from larger water bodies. Correlation analysis revealed significant positive relationships between temperature and water body metrics (r > 0.75), with smaller water bodies exhibiting the strongest temperature sensitivity. Conversely, precipitation generally had weak or negative correlations with water dynamics, notably in permafrost zones, where heavy rainfall often promoted drainage and lake outflow. Seasonal frost zones showed limited precipitation sensitivity due to higher infiltration rates. [Conclusions] Rising temperatures predominantly drove surface water expansion, surpassing the effects of precipitation. Permafrost zones were highly sensitive to warming, evidenced by rapid increases in small water bodies, while seasonal frost zones exhibited stable water body counts with area expansion driven by larger lakes. Precipitation played a secondary or even negative role in water dynamics. The distinct responses of water bodies under different freeze-thaw conditions highlight the complexity of hydrological changes driven by climate warming, providing crucial insights for future environmental predictions and resource management on the Qinghai-Tibet Plateau.