PURPOSE: Open globe injuries (OGIs) are categorized by zone, with Zone 3 (Z3) comprising wounds >5mm beyond the limbus. Outcomes of Z3 OGIs are highly heterogenous. OGIs with far posterior wounds (pZ3) were hypothesized to have worse visual and anatomic outcomes. DESIGN: Single-center retrospective cohort study PARTICIPANTS: 258 eyes with zone 3 open globe injuries METHODS: A retrospective review of Z3 OGIs treated at a tertiary center over 12 years. Wounds ≥10mm posterior to the limbus were defined as pZ3. Outcomes were compared between pZ3 and anterior Z3 (aZ3) eyes. MAIN OUTCOME MEASURES: Visual acuity on a logMAR scale. Secondary outcomes included anatomic outcomes, development of retinal detachment (RD) and proliferative vitreoretinopathy (PVR), and number of secondary surgeries. RESULTS: A total of 258 Z3 OGI eyes with >30 days follow-up were assessed; 161 (62%) were pZ3. At 3 month follow-up, pZ3 OGIs were more likely to exhibit NLP (pZ3: 38%; aZ3: 17%; p<0.003), lack count fingers vision (pZ3: 72%; aZ3: 43%; p<0.002) and fail to read a letter on the eye chart (pZ3: 83%; aZ3: 64%; p<0.001). The visual acuity distribution at 3 months was significantly worse for pZ3 compared to aZ3 injuries (p<0.004). Similar results were found at final follow-up. Multiple linear regression showed that pZ3 location was independently associated with worse visual acuity (β 0.29, 95% CI: 0.09-0.50, p<0.006) in addition to presenting acuity, age, vitreous hemorrhage, uveal prolapse and afferent pupillary defect. pZ3 injuries were more likely to develop RDs (pZ3: 87%; aZ3: 71%; p<0.01) and PVR (pZ3 66%; aZ3 47%; p<0.03). Patients with pZ3 OGIs were significantly more likely to reach a poor anatomic outcome (phthisis, enucleation, need for keratoprosthesis) compared with aZ3 OGI patients (pZ3: 56%; aZ3: 40%; p<0.03). CONCLUSION: Posterior OGI extension independently portends worse visual and anatomic outcomes. The effect on visual outcome was durable and clinically relevant compared with established predictors of OGI outcomes. Application of these findings improve prognostic precision and will guide future research efforts to optimize surgical decision-making in severe OGI cases.