Recently, research on outstanding universal value (OUV) protection and tourism development at World Natural Heritage sites (WNHSs) has attracted scholarly attention. The aesthetic value of natural landscapes is a powerful driving force for tourism development. Using this approach as an entry point to study aesthetic value protection and tourism development will help to relieve the contradiction between protection and development and promote the sustainable utilization of heritage sites. However, no comprehensive literature review has examined research on aesthetic value protection and tourism development at WNHSs. To fill this gap, we used a systematic literature review framework, and bibliometric analyses of 194 journal articles were collected from the Web of Science (WOS) and China National Knowledge Infrastructure (CNKI) databases. The results show the following: (1) the overall fluctuating upward trend in the number of publications indicates that the research in this field is gradually expanding, the regions studied in the literature are mainly focused on China, Italy and Australia, and the research institutions conducting the research are mainly Asian universities. (2) The landmark research achievements mainly focus on theoretical foundation, model construction, monitoring and evaluation, technical measures and other dimensions and the implications for World Heritage karst sites (WHKSs), where theoretical research is the main focus, and that research on monitoring and evaluation, technical measures and model construction is relatively limited. (3) On this basis, 7 key scientific and technological issues are summarized and provide insights into future research directions for the conservation of aesthetic values and tourism development at WHKSs, and future research should strengthen knowledge of natural heritage conservation based on aesthetic value identification and focus on the theoretical basis of the coordination between the conservation of aesthetic value and tourism development at WNHSs. Research should explore the science and technology and measures associated with the coordination between aesthetic value conservation and tourism development, and reveal the mechanisms and paths for coordination between WNHS conservation and tourism development in karst areas.