Isolated oculomotor palsy secondary to herpes zoster is rare. We will discuss a case presenting with headache, ptosis and dilated pupil. (See Figs. 1 and 2.) A 43 years old Indonesian female, presented to Emergency department with headache of 2 days, double vision and drooping of left eye. She had crusted rash in ophthalmic distribution of the trigeminal nerve, partial left oculomotor nerve palsy with tonic dilated left pupil with partial left ptosis and restricted upgaze. CT brain, CT angiogram of head, MRI brain were unremarkable. Cerebrospinal fluid showed 100% lymphocytes with raised protein; Herpes simplex and Varicella zoster DNAP-PCR were negative. She was treated with IV acyclovir for 14 days, Gabapentin, followed by 14 days of Valacyclovir and tapering dose of steroids. She had minimal headaches and recovering ophthalmoplegia at 2 weeks follow-up. Fig. 1. Crusted lesion in the left ophthalmic branch of trigeminal nerve with left oculomotor palsy Fig. 2. Dilated tonic pupil of the left eye In presentations with headache, ptosis and dilated pupil, first rule out aneurysmal compression of third cranial nerve. Our patient had history of herpes zoster affecting the ophthalmic division of the trigeminal nerve and presented with isolated oculomotor palsy. Differential diagnosis includes zoster meningitis and should be treated appropriately. Isolated oculomotor palsy secondary to herpes zoster although rare should be considered in a patient with headache, ptosis and dilated pupil with history of herpes zoster. Treatment with antivirals and corticosteroids usually results in good prognosis.