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To assess the herpes simplex virus–specific tear secretory IgA (sIgA) and its correlation with specific serum antibodies and to evaluate the possible value of specific tear sIgA for prediction of herpes simplex keratitis (HSK) recurrence.Tear sIgA and paired serum IgG/IgM/IgA from 41 stromal HSK patients and 15 controls were analyzed by enzyme-linked immunosorbent assay. Subsequent follow-up for monitoring recurrence was performed from the time of first cure on all patients for 4 months to 1 year.Serum IgG was positive in all participants. The concentration of serum IgA increased with the levels of tear sIgA (P = 0.017). The tear sIgA–positive rate was 36.59% in stromal keratitis, whereas none of the controls were found as sIgA positive. Positivity of sIgA was the only potential factor for predicting the risk of herpes keratitis recurrence (hazard ratio = 9.04; 95% confidence interval, 1.06–77.44; P = 0.045), with a sensitivity of 83.3% and a specificity of 71.4% (P = 0.034; 95% confidence interval, 0.58–0.97). Tear sIgA–positive patients had significantly shorter relapse-free survival compared with tear sIgA–negative patients (P = 0.015).This is the first preliminary study suggesting that the levels of tear sIgA could be a potential prognostic parameter for the recurrence of HSK.