Objective To evaluate the effect of the hierarchical comprehensive training system in the teaching of primary surgery for open globe injuries. Methods A retrospective analysis was conducted on the use of the hierarchical comprehensive training system for the teaching of primary surgery for open globe injuries among residents rotating the ocular trauma department in the ophthalmology standardized training base of Beijing Tongren Hospital from January 2023 to December 2023. The experimental group used a hierarchical comprehensive training system that integrated theoretical lectures, video teaching, Wetlab training and clinical practice, while the control group used the traditional clinical apprenticeship teaching model. The teaching effect was evaluated by surgical assessment for both groups, and a questionnaire survey was conducted for the experimental group. Data analysis was performed using t-test and χ² test. Results The average surgery time of the experimental group was significantly shorter than that of the control group [(27.0±1.5) minutes vs. (28.9±1.7) minutes, P<0.001]. The total score for the surgery assessment of the experimental group was significantly higher than that of the control group [(90.64±4.91) vs. (82.86±7.44), P<0.001]. The results of the questionnaire showed that students in the experimental group believed that the hierarchical comprehensive training system was helpful in adapting to microsurgery more quickly and improving the proficiency of basic operations (satisfaction rate was 100% for both). Conclusions The hierarchical comprehensive training system can effectively enhance the proficiency and level of surgical operation in primary suture surgery for open globe injuries among standardized training ophthalmology residents.