Background/Objectives <p>Toxic Epidermal Necrolysis Syndrome (TENS) is a rare, life-threatening, immune-mediated acute blistering reaction affecting the skin and mucosa. Ocular involvement with inflammatory de-epithelialisation is seen in &gt;60% of patients, with severe cicatrising consequences. Management includes intensive steroid and lubricant eyedrops, Amniotic Membrane Transplantation (AMT) and co-ordinated multidisciplinary care of systemic illness. We assessed the incidence, severity and management of ocular involvement in TENS over a decade at Chelsea and Westminster Hospital.</p> Methods <p>Retrospective review of TENS patients treated in the Burns Unit at Chelsea and Westminster Hospital between 2013 and 2023.</p> Results <p>Of 24 patients with TENS, 16 (66%) had ocular involvement. The most common culprit drug was lamotrigine (six patients). Seven patients (44%) developed “mild to moderate” disease of whom four recovered without sequelae whilst three developed mild dry eye or minor lid changes. Nine patients (56%) developed “severe to extremely severe” disease and all underwent AMT. Despite this, five developed sight-threatening complications including corneal perforation, limbal stem cell failure, scarring, symblepharon, ankyloblepharon, entropion and trichiasis. Three patients had excellent outcomes following AMT with minimal sequelae, and one patient died from systemic disease. Ocular disease severity significantly correlated with delayed skin re-epithelialisation (<i>p</i> = 0.043). All patients received intensive eye drops and systemic immunosuppression.</p> Conclusions <p>Lamotrigine was the leading culprit drug in our cohort. Greater ocular disease severity was associated with delayed skin re-epithelialisation. Corneal involvement was associated with a higher chance of sight-threatening complications despite intensive treatment. Early ophthalmic input, multidisciplinary care, and timely AMT are critical for preserving vision.</p>