We reviewed retrospectively the records of 12 patients with herpes zoster keratopathy who had undergone penetrating keratoplasty. Preoperatively, seven patients (58%) had noninflamed eyes with visually significant corneal scarring or edema. Five patients (42%) had progressive neurotrophic corneal ulceration, and four of those had corneal perforation. Tarsorrhaphies were placed in ten patients and appeared to be beneficial in preventing postoperative breakdown of the corneal surface. At an average follow-up time of 36 months, ten of the 12 grafts (83%) remained clear, with nine patients (75%) having a visual acuity of 20/80 or better.