Ophthalmic herpes simplex viral keratitis (HSVK) is responsible for a range of ocular manifestations from superficial epithelial disease to stromal keratitis and endotheliitis. The Herpetic Eye Disease Study (HEDS) has guided the management of herpetic eye disease for almost twenty years, but newer medications such as valacyclovir are now available and are considered to have better bioavailability than acyclovir. In this review, we examine the existing evidence on the pathogenesis of different HSVK disease modalities and the role of oral and topically administered antiviral drugs in the treatment of herpes simplex viral keratitis.