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The ersatz eye from Xanathar's Guide to Everything (p. 137) seems to me as (almost) an entirely cosmetic item.
It would seem to that the loss of an eye is a storytelling option, and the choice to remedy it by using the eye (rather than some sort of healing) is also more of a "rule of cool" thing rather than something that gives a mechanical benefit.
Is there some rule or game mechanic that I'm overlooking that requires that this item need attunement?
The Dungeon Master's Guide contains rules for lingering injuries, including the loss of an eye. If those rules are in use, then this item would provide a way to mitigate one of those results at the cost of an attunement slot.
In a game where the lingering injuries table isn't in use, there's no mechanical benefit to this item and no need for it to require attunement.
The designers have erratic rules on attunement.
See the DMG p285
If having all the characters in a party pass an item around to gain its lasting benefits would be disruptive, the item should require attunement. If the item grants a bonus that other items also grant, it's a good idea to require attunement so that characters don't try to collect too many of those items.
However, lots of items, like Wands of Spells, Boots of Elvenkind, Wand of Magic Missiles, Cape of the Monteback, Stone of Controlling Earth Elementals and Gem of Brightness don't require attunement and are great for passing around and are disruptive to having all members of the party have it.
Also, lots of items that could easily be a scroll and are really niche and not great to pass around or that disruptive require attunement, like the Trident of Fish Command, and the Ersatz Eye. It's best not to assume that items will be perfectly labelled by some consistent scheme that makes sense.
That said, there are some uses you could gain, above and beyond normal eyes, some more mechanical benefits.
The Curse of Strahd has a blessing you get which gives you a blind eye.
The vestige within this sarcophagus offers the dark gift of Drizlash, the Nine-Eyed Spider. Drizlash's gift is the power to walk on walls and ceilings. This dark gift allows its beneficiary to climb difficult surfaces, including upside down on ceilings, without needing to make an ability check.
The beneficiary of this dark gift grows an extra eye somewhere on its body. The eye is blind and ever open.
You could theoretically replace this eye with a functioning one, and be able to see from places other than your head, so long as you can find a way to produce new eye sockets.
You could use it to hide another object behind the eye and remove it when needed. Few people think to check an eye socket for hidden items. This comes from the fact that it can be removed at will, unlike normal eyes for which there comes heavy consequences for removal.
Magical objects are resistant to most forms of damage. As such, you can endanger your eye in ways you couldn't endanger your real eyes.
It can't be pulled out by outsiders, so it's easier to keep the item if you are defeated, or use it to win dares as to whether strangers can pull it out.
The only ways that I can think of to restore lost body parts are the 7th level Bard/Cleric/Druid spell Regenerate, associated magic items, and high level resurrection magic.
There are no formal guidelines for the price of spellcasting services but according to the Adventures League formula a 7th level spell without costly components would cost 490 gp.
A Ring of Regeneration as a very rare item would be between 5,000 and 50,000 gp while resurrection magic that can restore limbs would be around 1,000 gp for the components alone.
A common magic item, according to the DMG (135) would be between 50-100 gp. This makes it much more affordable to low level adventurers and accessible to poorer NPCs.
A character who lost an eye would be highly motivated to regain it in some way considering, according to the DMG rules on lingering injuries (272) they would suffer disadvantage on sight based Wisdom (Perception) checks and ranged attack rolls.
With regards to why the designers would make the Ersatz Eye require attunement it has been judged that questions of designer intent are off topic
If you are wondering whether removing the attunement requirement would create issues in your game I would suggest not, especially considering that the only way a character would be missing an eye is if the DM chose to use the rules for lingering injuries/made it happen in the story or if they chose to be missing an eye at character creation.
