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To report the long-term results of keratoplasty in patients with herpes zoster ophthalmicus (HZO).All 14 patients underwent keratoplasty for a corneal scar or a perforated corneal ulcer due to HZO at the Wills Eye Institute from January 1999 to August 2011.We performed 9 penetrating keratoplasties and 1 deep anterior lamellar keratoplasty for corneal scarring, and 4 tectonic penetrating keratoplasties for perforated corneal ulceration due to HZO. Eight of the 14 eyes had a temporary tarsorrhaphy concurrent with graft. Postoperative follow-up time ranged from 12 to 132 months (mean 64 ± 38). Postoperatively, the most common complications were dense superficial punctate keratopathy and severe dry eye because of neuropathic keratopathy in 8 eyes, graft rejection in 5 eyes, and secondary glaucoma in 4 eyes. All grafts were clear, and best spectacle–corrected visual acuity was 20/40 or better in 6 eyes (42.8%) and 20/100 or better in 9 eyes at their final evaluation (64.2%).Although the sample size is small, we demonstrate that very good visual results in long-term follow-up can be achieved when keratoplasty is performed in patients with herpes zoster virus keratopathy. We believe that longer quiescent waiting period between active herpes zoster ocular involvement and keratoplasty may promote better visual results.