HSV Stromal keratitis is a significant cause of corneal blindness worldwide and is a result of inflammatory response to HSV reactivation within the corneal stroma. If left untreated, it can lead to progressive corneal scarring and neovascularization. This chapter provides review of its etiology, epidemiology, pathophysiology, clinical presentation, and management. The chapter also highlights the role of antiviral therapy in controlling viral replication and the critical importance of anti-inflammatory treatment, particularly corticosteroids, in managing stromal inflammation. Prophylactic strategies, including long-term antiviral suppression, are discussed to prevent recurrences in individuals with a history of recurrent HSV keratitis. This comprehensive overview aims to help in effective management of HSV stromal keratitis, improve patient prognosis, and minimize the risk of vision-threatening complications.