Herpes zoster ophthalmicus (HZO) is a subset of herpes zoster (HZ) that involves the ophthalmic branch of the trigeminal nerve; approximately 4–20% of patients with HZ develop HZO.

The clinical signs and symptoms of HZO include a facial herpetic rash associated with, and sometimes preceded by, neuropathic pain, fever, and headache; extension of the rash to the tip of the nose (Hutchinson’s sign) indicates involvement of the nasociliary branch and increases the likelihood of ocular involvement.

HZO can affect all the structures of the eye from the cornea to the retina and lead to severe complications, including loss of vision; early referral of a patient with a characteristic rash in an ophthalmic area to an ophthalmologist is essential to prevent such long-term irreversible damage.

Early initiation of antiviral therapy can minimize the risk of ocular complications in patients with HZO.

Vaccination is recommended to prevent HZ and HZO; it is important that primary care physicians prioritize vaccination of eligible patients as part of a comprehensive vaccination program in adults.