Background: Trigeminal post-herpetic neuropathy (TG-PHN) is a chronic neuropathic pain disorder that may follow reactivation of varicella-zoster virus within the trigeminal sensory system. It is particularly important when the ophthalmic division is involved because persistent facial pain and sensory dysfunction may coexist with ocular morbidity.

Objective: This narrative review summarizes current evidence regarding the epidemiology, risk factors, pathophysiology, clinical manifestations, diagnosis, management, prevention, prognosis, and future research priorities of TG-PHN.

Methods: A narrative review of peer-reviewed literature was undertaken using PubMed/MEDLINE, Embase, Scopus, Web of Science, and Google Scholar. The review emphasized literature published from January 2021 through June 2026, while earlier landmark studies and established classification documents were retained when necessary. Trigeminal-specific evidence was prioritized, with broader post-herpetic neuralgia literature included selectively when clinically applicable.

Results: TG-PHN is characterized by persistent or recurrent neuropathic pain and sensory abnormalities within trigeminal distributions previously affected by herpes zoster. Advanced age, severe acute zoster pain, greater rash severity, prodromal pain, impaired immunity, and selected comorbidities are associated with increased risk of persistent post-herpetic pain. Peripheral nerve injury, neuroinflammation, altered nociceptor excitability, deafferentation, and central sensitization contribute to persistent symptoms. Diagnosis remains primarily clinical. Management is individualized and may include gabapentinoids, tricyclic antidepressants, topical therapies, and selected interventional approaches for refractory disease. Prevention through appropriate management of acute herpes zoster and recombinant zoster vaccination remains important.

Conclusion: TG-PHN is a heterogeneous and potentially disabling neuropathic disorder requiring individualized multimodal management. Trigeminal-specific evidence remains limited, particularly for interventional therapies. Larger prospective studies and well-designed clinical trials are needed to better define disease phenotypes, natural history, treatment response, and long-term outcomes.