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To report the management of a patient with chronic herpes zoster ophthalmicus with previously undiagnosed natural killer cell deficiency. A 50-year-old female presented with herpes zoster ophthalmicus that despite appropriate treatment progressed to uveitis and expansion of the lesions. Multiple attempts to wean the patient off therapeutic anti-viral medications continued to result in reoccurrence of the disease. Discovery of underlying natural killer cell deficiency prompted indefinite treatment with therapeutic anti-viral medication. After multiple flares of herpes zoster ophthalmicus over 3 years, seven prior to the discovery of the immunodeficiency, she developed unilateral corneal scarring on the affected side. At this time, her visual acuity was measured to be uncorrected at 20/150 with improvement to 20/25-1 with refraction. This case highlights the need for further immunological investigation and unconventional medical management with recurrent viral infections to prevent visual morbidity. [ABSTRACT FROM AUTHOR]