We reviewed three representative cases of chronic corneal fistula formation and provide a systematic approach to the assessment and therapeutic alternatives for this problem. In two of our patients, the fistula was managed surgically. The third patient developed endophthalmitis, which resulted in loss of light perception. Chronic corneal fistulization is a rare clinical entity resulting from malapposition of corneal tissue after traumatic, surgical, or infectious perforation. Fistulas may result in prolonged or recurrent hypotony, peripheral anterior synechia formation, or endophthalmitis. Accurate assessment of the risks associated with corneal fistula formation takes into account the type of fistula, its location in the cornea, and the condition of the ocular adnexae. We reviewed the risk factors that will determine the urgency and type of therapy used.