I think it'd be fun if they were activated in the real world as she struggles to maintain them because seeing this and not being able to describe it to those who want to help her would be a good reason her family would ship her off. They just wouldn't let their prized heir go away without a caretaker unless they thought it could legitimately help.

In the fourth movie, her eyes are bandaged so that may be a route we can go with here until she's learned to control them via Contract Duels. I was thinking since there's no one like Touko here that most of the academic faculty wouldn't know what she's going through and therefore can't coach her on what they are.

No one will actually die as a result of them. She can break objects, kill plants and maybe small creatures at most. In Contract Duels, she can severely wound people (not permanently), but no death until it's applicable for plot. Which could be never since Shiki finds the thrill in fighting, not killing.