Since its recent introduction into the Mediterranean area, Tuta absoluta (Meyrick) has become widespread and an important pest throughout the region, including in Tuscany, where it was first recorded in 2009. Although several studies have been conducted within controlled environments on the ecology and management of T. absoluta, limited information is currently available on the importance of this pest in open-field cultivations, which may lead to ineffective management strategies. This study was carried out to monitor fluctuations in adult populations of T. absoluta in organic and conventional cultivations of processing tomatoes using pheromone lures, and to collect inter-annual data on direct yield loss and fruit damage from larval feeding in two separate trials in Grosseto (Tuscany). The first trial included eight conventionally managed fields; the second trial was carried out in four organically managed fields. Results show relatively higher crop damage for tomatoes transplanted later in the season and harvested towards the end of August to early September, and limited fruit damage from this pest during the second year of the study for both conventional and organically managed fields. Finally, biological and chemical pest management strategies for the control of T. absoluta adopted by farmers within the region are reviewed and discussed.