Pathological ocular angiogenesis is a key pathological process occurring in multiple sites including the retina, choroid and cornea, which leading to vitreous hemorrhage, choroidal neovascularization, or corneal opacity, and has become one of the primary causes of irreversible blindness worldwide. Angiogenesis originates from the formation of new branches within existing vascular networks, relying on a series of steps including endothelial cell activation, migration, and lumen formation. Metal ions are essential elements for living organisms, and plays critical roles in almost all fundamental biological processes. Within metalloproteins, metal ions primarily perform three functions: providing structural stability, acting as cofactors for enzymatic reactions, and mediating electron transfer. Among these, five metal ions——iron, copper, zinc, calcium and manganese are particularly crucial for metabolic regulation. Recent years, the significant advances has been witnessed in understanding how these metal ions drive pathological ocular angiogenesis through multi-level mechanisms. Core regulatory pathways involve ferroptosis, cupric death, zinc finger transcription regulation, calcium signaling cascades, and manganese enzyme-mediated control. The aforementioned pathways and their latest discoveries were systematicly reviewed, aiming to provide new theoretical perspectives and strategic insights for targeting metal ion homeostasis pathways in the treatment of neovascular eye diseases.