Background: Herpes simplex virus (HSV) keratitis is a recurrent corneal disease that remains a significant cause of ocular morbidity due to its variable clinical presentation and potential for progressive corneal damage. Understanding the clinical spectrum and recurrence patterns of HSV keratitis is essential for effective long-term management, particularly in tertiary eye care settings. Methods: This retrospective study was conducted at the National Institute of Ophthalmology and Hospital, Dhaka, Bangladesh, from April 2012 to March 2013. A total of 40 patients with recurrent HSV corneal infections were included, with disease duration ranging from 1 to 22 years. Only patients with more than one documented recurrence were enrolled. Patients with incomplete records, uncertain diagnosis, or stromal keratitis at initial presentation were excluded. Clinical data were analyzed to assess age distribution, initial disease pattern and recurrence behavior. Results: The majority of patients were middle-aged, with 52.5% between 31 and 50 years and the highest prevalence in the 41–50 age group (27.5%). Disciform keratitis was the most common initial presentation (62.5%), followed by epithelial keratitis (27.5%) and uveitis (10%). Among patients initially presenting with disciform keratitis, 84% experienced recurrence with the same pattern, while 8% developed neurotrophic keratitis. Patients initially presenting with epithelial keratitis predominantly showed epithelial recurrences (72.7%), though 27.3% progressed to disciform keratitis. Conclusion: Recurrent HSV keratitis predominantly affects middle-aged adults and most commonly presents as disciform keratitis in tertiary care settings. Recurrences tend to follow the initial disease pattern, although progression from epithelial to stromal involvement occurs in a notable proportion of cases, emphasizing the need for long-term follow-up.