Reactivation of the herpes zoster virus, or shingles, in the fifth cranial nerve can lead to herpes zoster ophthalmicus. In this condition, dendrite keratopathy along with uveitis can lead to marked pain and visual loss. Involvement of the skin at the tip of the nose, supplied by the nasociliary nerve, is often associated with ocular involvement. Treatment with oral acyclovir or its derivatives often can reduce symptoms and shorten the course of the disease. If ophthalmic involvement is suspected, the patient should be evaluated by an ophthalmologist. The recent introduction of a vaccine to prevent herpes zoster in patients more than 60 years old may have an impact on the incidence of herpes zoster ophthalmicus in the future.