Introduction: Herpes Zoster Ophthalmicus (HZO) is a viral infection caused by varicella zoster virus. The virus manifests in primary and recurrent forms. HZO involves ophthalmic division of trigeminal nerve affecting one or all other branches (lacrimal, supratrochlear, nasociliary). The diagnosis is simple with clinical examination in majority of cases. The lifetime risk of herpes zoster is estimated to be 10 to 20 percent. The complications are seen in primary and recurrent herpes zoster both in immunocompetent and immunocompromised patients. Aims: To analyses varied clinical manifestation in herpes zoster ophthalmicus. Materials and Methods: We analysed 40 cases of established HZO. The demographic profile, clinical signs and symptoms, and outcomes were observed and analysed. They were screened for diabetes and hypertension as a part of routine checkup. HbA1c (glycosylated Hb) was done in all diabetics. Serological testing for HIV, HbsAg, & VDRL was done in all cases. History of chicken pox in the past was documented if any. Results: All 40 cases had conjunctival and corneal involvement. 11(27.5%) out of 40cases, had complete dermatomal involvement,17(42.5%) had intra ocular involvement. 7 patients had uncontrolled diabetes with HbA1c values between 8 to 10. 13 patients had deep seated retro ocular pain before the onset of skin leision. Conclusion: HZO take a longer course in patients with abnormal HbA1c values. Multiple dermatomal involvement can be observed. Deep seated retro ocular pain along with burning sensation along the distribution of nerve should arouse high index of suspicion of HZO, as a premonitory symptom. The skin lesions appear different with edematous skin in albino patient.