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Herpes zoster ophthalmicus (HZO) is a viral infection that affects the ophthalmic branch of the trigeminal nerve. HZO is potentially sight-threatening, affecting 4%–20% of all zoster cases. The reported incidence of zoster has quadrupled in the past 60 years, affecting approximately 1 million people per year in the USA and 12.2 per 1000 population in those aged >85 years in the UK.The incidence and severity of vision-threatening complications are moderated by prompt antiviral therapy. Valaciclovir has numerous advantages over aciclovir, including superior bioavailability, higher blood antiviral activity, a longer half-life and simpler dosing regimen. Suppressive antivirals are commonly used as secondary prophylaxis following an episode of HZO, but the evidence to support this practice is weak.Varicella zoster virus is the only human herpesvirus for which highly effective vaccines are available. The recombinant zoster vaccine (Shingrix, GlaxoSmithKline) is a highly effective vaccine in preventing zoster, HZO and postherpetic neuralgia, with vaccine effectiveness of 70%–86%, 67%–93% and 76%, respectively. In this update, the current evidence for the prophylaxis and management of HZO, including keratitis, is evaluated.