This chapter focuses on the management of surgical treatment for severe combat-related ocular trauma, one of the most challenging issues in ophthalmic surgery during modern armed conflicts. The chapter presents the experience of the OCHI Clinic (Kyiv, Ukraine) in providing specialized care to military personnel and civilians with penetrating and perforating eye injuries, ruptures, and combined ocular damage. It provides statistical data on the incidence of ocular injuries, presents clinical cases, and analyzes challenges associated with the removal of intraocular foreign bodies, treatment of lens dislocations, aniridia, and retinal detachment. Contemporary approaches to reconstructive vitreoretinal surgery are described in detail, including two-stage techniques (vitrectomy followed by implantation of an iridocapsular diaphragm) and minimally invasive procedures utilizing 25G and 27G systems. Special attention is given to the optimal timing of reconstructive surgeries (3–14 days after primary microsurgical wound treatment), the selection of techniques based on injury severity, and the prevention of complications. The chapter also discusses current trends in ophthalmic surgery for combat injuries and explores future directions for refining surgical strategies.