Ocular trauma is a leading cause of visual impairment in the United States. Despite advances in treatment, almost half the patients with posterior, penetrating ocular injuries have permanent, severe visual loss. There is controversy with regard to the optimal role and timing of vitrectomy in the management of posterior segment injuries, as well as the proper management of magnetic intraocular foreign bodies. Improvements in surgical instrumentation and technique, combined with an increased understanding of posterior segment pathobiology, continue to modify the indications for treatment. Each of these issues is discussed in light of recent contributions to the literature.