The authors studied the hospital records of 453 patients who underwent primary surgical repair of penetrating ocular injuries at the Wilmer Institute from January 1970 through December 1981. The injury was due to blunt force in 22%, a sharp laceration in 37%, and a missile in 41%. The following factors correlated with the final visual outcome: (1) initial visual acuity after the injury, (2) presence of an afferent pupillary defect, (3) type of injury, (4) location and extent of the penetrating wound, (5) type of lens damage, (6) presence and severity of vitreous hemorrhage, and (7) type of intraocular foreign body. This study emphasizes that the prognosis after a penetrating injury is strongly influenced by the nature of the injury and the extent of initial damage.