Herpes Zoster Ophthalmicus (HZO) is a reactivation of the Varicella Zoster Virus (VZV) in the ophthalmic division (V1) of the trigeminal nerve, affecting the skin and ocular structures. It commonly occurs in older adults and immunocompromised individuals, presenting with a painful unilateral skin rash, often accompanied by ocular complications such as conjunctivitis, keratitis, uveitis, and glaucoma. Hutchinson’s sign, indicating nasociliary nerve involvement, is a key predictor of severe ocular involvement. The pathophysiology involves viral reactivation from its latent state in sensory ganglia, leading to neural inflammation and damage, which contributes to post-herpetic neuralgia (PHN). Diagnosis is primarily clinical, with laboratory confirmation in atypical or immunosuppressed cases. Early antiviral therapy within 72 h of symptom onset reduces severity and complications. Topical antivirals, corticosteroids, and intraocular pressure management are essential for ocular involvement. Surgical interventions may be required for corneal complications and non-healing ulcers. Despite treatment, HZO can lead to long-term complications, including chronic ocular inflammation, vision loss, and post-herpetic neuralgia. Preventive measures such as vaccination in high-risk populations can significantly reduce disease incidence and severity.