In recent years, more and more elderly patients have developed cephalofacial herpes in clinical practice, and many of them have developed sequelae due to untimely treatment, and some have even developed blindness in the affected eye. With timely neuroprotective treatment, the majority of patients with cephalofacial herpes can be treated without sequelae, especially in patients with blindness due to untimely treatment. Next, I will tell you about herpes cephalad. Herpes zoster is a viral skin disease caused by varicella zoster virus, which is characterized by clusters of herpes and neuralgia along the trigeminal nerve distribution area. It is common in middle-aged and elderly people, and the incidence increases with age. When first infected, the virus enters the body through the respiratory mucosa and spreads through the bloodstream. Chickenpox can appear on the facial skin or oral mucosa and does not appear after infection, which is a recessive infection and becomes a carrier of the virus. This virus is neurophilic, after invading the nerve endings of the skin, it can move along the trigeminal nerve to the ganglion and latent there, when the patient’s immune function is low, such as exertion, cold, fever, the virus attacks causing inflammation of the ganglion, the virus moves along the trigeminal nerve to the skin again to occur herpes, this process is mostly seen in middle-aged and elderly people. After developing shingles, patients generally acquire lifelong immunity to the virus. The onset of herpes zoster on the head and face is preceded by a localized burning pain in the skin, accompanied by systemic symptoms such as mild fever, fatigue and weakness. However, there can be no prodromal symptoms, and after 1 to 3 days, scattered erythematous patches of skin appear one after another. After 1 to 3 days, scattered erythematous spots appear on the skin, followed by clusters of papules from corn to green bean size on the erythematous spots, which rapidly turn into blisters. The blister walls are tense and shiny, the blister water is clarified, and there are small depressions on most of the blister surface. After a few days, the herpes becomes cloudy and purulent and breaks down to form a vesicular surface, the surrounding skin is congested and red, and the lymph nodes on the face and upper neck are enlarged and inflamed. The herpes area eventually dries and crusts over, leaving temporary erythema after the scabs fall off. The disease usually lasts 2 to 4 weeks and is self-limiting. The distribution of herpes is mostly located on one side of the head and face, unilateral, arranged in bands, and generally does not exceed the midline of the face. Herpes zoster is prevalent in the facial and oral trigeminal nerve distribution, usually involving only one branch of the trigeminal nerve subdivision. Facial or submandibular lymph nodes are often enlarged and painful. Severe neuralgia is another major symptom of the disease, with a distribution by nerve, often becoming more pronounced with age. The pain can occur before the rash appears and is manifested by sensory sensitization of the affected skin, which induces pain upon light touch. The pain is caused by a viral infection that causes an inflammatory response in the trigeminal ganglion. Sometimes there is severe neuralgia before the appearance of herpes, which is often misdiagnosed as toothache or trigeminal neuralgia. Elderly and frail patients often have sequelae of neuralgia, which can sometimes last for several months. If herpes occurs in the ophthalmic branch of the facial trigeminal nerve, conjunctival and corneal herpes can occur, leading to corneal ulceration and even blindness, which is a serious complication. When the virus invades the facial and auditory nerves, herpes in the ear shell and external auditory canal may be accompanied by deep pain in the ear and mastoid process, tinnitus, deafness, facial nerve paralysis and loss of taste sensation in the anterior 1/3 of the tongue, which is called “herpes zoster facial palsy syndrome”. Therefore, the treatment of herpes is mainly to prevent the emergence of sequelae as a priority, or as I said before: early neuroprotective treatment, sequelae are prevention rather than treatment.