The abrasion damage of concrete structures caused by high-speed water flow with sediment is one of the main durability issues of hydraulic structures. In recent years, the application of high-performance impact resistant concrete materials has been a favorable way to alleviate this problem. In this paper, the high-speed underwater steel ball method was used to simulate the high-speed water flow abrasion environment, and the abrasion damage process, characteristic laws and mechanisms of UHPC were discussed. The results show that the impact wear damage of UHPC under the action of high-speed underwater steel balls goes through stages such as surface mortar layer wear, matrix and aggregate peeling, and gradually increasing wear degree. The wear rate follows a power function relationship with time. Combining 3D scanning visualization and quantitative analysis can accurately evaluate the impact and wear resistance performance of UHPC comprehensively. The change in water-binder ratio significantly affects the impact and wear resistance of UHPC. When the water-binder ratio increases from 0.16 to 0.18 and 0.2, the wear rates increase by 132.5% and 155%, respectively. The addition of silica fume can effectively increase the indentation modulus and hardness of UHPC matrix, reduce the thickness of ITZ, and optimize the pore structure. When the content of silica fume is 10% and 20%, the thickness of ITZ decreases by 50% and 62.5%, respectively, and the corresponding impact abrasion strength increases by 52.5% and 60.4%, respectively. Therefore, it can be considered to improve the impact and wear resistance of UHPC by optimizing the pore structure, enhancing the ITZ performance, and increasing the matrix hardness.