Herpes zoster ophthalmicus (HZO) is a potentially sight-threatening viral infection of the trigeminal nerve caused by a localised reactivation of the varicella zoster virus, also known as human herpesvirus-3. It can cause painful skin rashes on one side of the forehead and scalp, and ocular manifestations include conjunctivitis, keratitis and uveitis on the same side. Two-thirds of cases occur in the over 50s. This Clinical Management Guideline outlines the aetiology, signs and symptoms and evidence-based recommendations for diagnosing and managing HZO. It highlights the need for emergency GP treatment and potential urgent hospital eye service referral, while outlining options for non-pharmacological management and pharmacological treatment of mild cases.

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