We conducted a prospective study of 100 consecutive Ethiopian patients with herpes zoster ophthalmicus (HZO); this study revealed a high incidence of HZO among the young (mean age, 35 years). Eighty-one (95%) of 85 patients who underwent serological testing were seropositive for antibodies to human immunodeficiency virus (HIV). Unlike previous investigators, we found a marked increase in the incidence and severity of eyelid (25%) and ocular (78%) complications as well as postherpetic neuralgia (55%). Visual loss occurred in 56% of the cases. Lack of medication, delay in presentation, severity of HIV-related HZO, and application of herbal medications adversely affected the outcomes for these patients. We conclude that all patients with HZO, especially those younger than 45 years of age, should be screened for HIV infection. Because HZO is a vision-threatening problem, all health care workers should become aware of its management.