Background: Open-globe injuries (OGIs) represent severe ocular emergencies with potentially devastating visual outcomes. These injuries, caused by penetrating or blunt trauma, require prompt diagnosis and management to prevent complications such as endophthalmitis, retinal detachment, and permanent vision loss. Despite advances in imaging and surgical techniques, diagnostic challenges persist, particularly in cases with subtle clinical findings. This review evaluates the diagnostic challenges, evidence-based management protocols, and prognostic factors associated with OGIs to guide clinicians in optimizing patient outcomes. Methods: A comprehensive literature review was conducted, analyzing studies on OGI epidemiology, pathophysiology, diagnostic approaches (clinical examination, imaging), and treatment strategies. Emphasis was placed on surgical interventions, antibiotic prophylaxis, and the Ocular Trauma Score (OTS) for prognostication. Results: OGIs exhibit distinct demographic patterns, with males and young adults at higher risk. Diagnostic accuracy relies on clinical suspicion, slit-lamp examination, and orbital CT, while MRI is contraindicated if metallic foreign bodies are suspected. Immediate management includes shielding the eye, avoiding pressure, and urgent surgical repair. Prognosis depends on initial visual acuity, injury location (posterior segment involvement worsens outcomes), and complications like endophthalmitis. The OTS provides a validated framework for predicting visual recovery. Conclusion: Early recognition, multidisciplinary collaboration, and adherence to evidence-based protocols are critical in managing OGIs. Future research should focus on standardized antibiotic regimens and innovative surgical techniques to improve functional outcomes.
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