The increasing prevalence of digital screen exposure and population aging poses rising threats to ocular health, driving the search for natural multi-target protective agents. Anthocyanins—water-soluble flavonoids abundant in dark-colored fruits and vegetables—have attracted considerable interest for their potential to prevent eye diseases. This review systematically evaluates the multi-dimensional protective mechanisms of anthocyanins, including antioxidant and anti-inflammatory activities, improvement of retinal microcirculation, promotion of rhodopsin regeneration and dark adaptation, and neuroprotection of retinal ganglion cells and photoreceptors. The extremely low oral bioavailability of intact anthocyanins is critically discussed, and the role of gut microbiota in converting anthocyanins into bioactive phenolic acid metabolites (e.g., protocatechuic, ferulic, and hippuric acids) is highlighted. The review also addresses structure-activity relationships, food matrix effects, and bioavailability-enhancing strategies such as nanoencapsulation, acylation/methylation, and synergistic combinations with other phytochemicals. Finally, future research directions and translational perspectives for developing anthocyanin-based functional foods and precision nutrition strategies are proposed, providing a comprehensive theoretical basis for leveraging anthocyanins in eye health management.