The surgical management of severe ocular burns is challenging and often associated with variable long-term outcome. The aims of this study were to analyze the clinical course of these injuries and determine the factors associated with the need for surgery. A retrospective medical records review was conducted for patients admitted to the Victorian Adult Burns Services, with ocular burns, from January 2000 to January 2010. One hundred and twenty-nine patients were admitted with ocular burns, of which 17 (13.2%) required surgery. The most common indication for surgery was ectropion (n = 9) and the most frequent procedure was full-thickness skin grafts to the eyelids (n = 10). Almost all patients managed surgically developed late ocular complications, the most frequent being visual loss and recurrent ectropion (n = 7 each). Patients undergoing surgery had a longer length of hospital stay (median [interquartile range] 40 [12–90] vs 12 [4–29.5] days; P = .004) and larger TBSA burned (median [interquartile range] 20 [10–60] vs 8 [4–20]; P = .011). Factors associated with the need for surgery included flame burns, periorbital edema, visual loss on presentation, increasing severity of eyelid and facial burns, severe corneal injury, as well as lagophthalmos, ectropion, and microbial keratitis (P < .05). Although only a minority required surgery, these patients often require multiple procedures and develop long-term ocular morbidity.