Introduction The purpose of this study is to evaluate the factors affecting multiple surgeries, worse visual outcome, eye removal (ER) and vitrectomy requirement in terror-related open-globe injuries (OGI) in the Turkish Military. Secondary purpose is to specify surgery and injury characteristics of terror-related OGI.

Methods A total of 372 eyes of 251 patients with OGI that occurred during terroristic attacks between January 1996 and January 2016 were included in the study. A retrospective investigation of the preoperative variables associated with further surgeries, visual outcome, vitrectomy requirement and evisceration/enucleation was achieved.

Results A total of 1118 separate operative sessions with a median of 2 (1–14) surgeries were performed to 372 eyes. Preoperative factors predicting follow-up surgery included visual acuity (VA) <20/200, lens injury, vitreous haemorrhage (VH), presence of vitreous prolapse. Baseline VA <20/200, initial retinal detachment and ruptured globe injury were the independent factors of worse visual result. Ruptured globe injury (p:0.000) and initial vitreous prolapse (p:0.001) were significantly linked to ER surgery. Patients required vitrectomy significantly tend to have VH (p:0.000) and zone 3 injury (p:0.000) compared with non-vitrectomy group. Single surgery cases tend to have significantly better baseline (p:0.000) and final VA (p:0.007) and shorter follow-up period (p:0.000) compared with multiple surgery group.

Conclusions Terror-related OGI necessitate remarkable surgical follow-up and multiple surgery sessions with a relatively higher evisceration/enucleation rate than other types of OGI. A comprehensive surgical approach with multiple surgery types is needed to treat terror-related OGI.