<p>Corneal alkali burns are severe ocular injuries characterized by extensive tissue damage, inflammation, oxidative stress, and neovascularization, which often lead to long-term visual impairment and corneal fibrosis. This review comprehensively examines the mechanisms underlying alkali burn injuries, including the roles of inflammatory mediators, oxidative stress, and cellular responses, while highlighting current and emerging therapeutic approaches. Traditional treatments, such as corticosteroids and surgical interventions, often have limited efficacy and significant side effects. Recent advances in innovative therapies, including stem cell-derived exosomes, hydrogel-based drug delivery systems, and herbal components, demonstrate significant potential for improving corneal healing and reducing complications. These novel approaches aim to mitigate inflammation, enhance epithelial repair, and prevent neovascularization, offering promising pathways for scar-free healing and the restoration of corneal transparency. Future research should focus on integrating these therapies into multifunctional treatment strategies to optimize clinical outcomes and improve quality of life for patients suffering from corneal alkali burns.</p>