We used a multivariate statistical analysis to identify factors predicting visual outcome in 281 eyes that underwent primary repair of a penetrating ocular injury. Visual acuity of 20/800 or better on initial examination was the most important factor, with these eyes 28 times more likely to have a final visual acuity of 20/800 or better than eyes with initial visual acuities worse than 20/800. The effect of other factors differed depending on the initial visual acuity. In patients with initial visual acuities of 20/800 or better, youth (less than or equal to 18 years) was a significant predictor of final visual acuities of 20/50 or better. In patients with initial visual acuities worse than 20/800, a laceration limited to the cornea was the best predictor of good visual outcome. Absence of an expelled or subluxed lens and lacerations limited to a location anterior to the rectus muscle insertions were also important predictors of good visual outcome. When an intraocular foreign body was present these factors were no longer significant and older age (greater than 18 years) was the most important predictor of good visual outcome.