From November 1986 to December 1993, 50 patients with 62 very severe eye burns were treated with Tenon plasty. Forty-one eyes showed widespread scleral ischemia, while 21 eyes had developed corneoscleral ulcerations. Surgery was done 3-126 days after the injury. A total of 210 quadrants was treated with Tenon plasty. Epithelization of the Tenon sheets was complete within 21 days in 79% and in all eyes up to 51 days. In all eyes corneoscleral ulcerations could be prevented or healed. In 48% isolated symblepharon formation or severe scarring of the fornices developed within 3 months after Tenon plasty. In these cases restoration of the conjunctiva was achieved by transplantation of autologous conjunctiva or nasal and buccal mucosa. Spontaneous epithelization of the burned cornea was achieved in 25.8%. In 36 eyes penetrating keratoplasty was performed. Sixteen (44.5%) grafts failed due to surface problems, while 12 (33.3%) grafts failed because of an endothelial immune reaction. Tenon plasty proved to be successful in preventing early necrolysis of the anterior eye segment in very severe eye burns. However, the prognosis for penetrating keratoplasty in these eyes is limited due to surface problems and immune reactions.