OBJECTIVE To evaluate corneal higher-order aberrations (HOAs) in eyes with corneal scars due to herpes simplex keratitis (HSK). METHODS Forty-four eyes of 41 consecutive patients who were diagnosed with corneal scars due to HSK and 18 control eyes were included. HOAs of the anterior and posterior surfaces and the total cornea were analyzed using anterior segment optical coherence tomography. Corneal opacity grades were assigned on the basis of slit-lamp examinations. RESULTS HOAs within a 4-mm diameter were significantly larger in eyes with HSK (anterior surface, 1.01 ± 1.18 μm; posterior surface, 0.25 ± 0.24; total cornea, 1.00 ± 1.00) compared with controls (0.10 ± 0.02, 0.02 ± 0.00, and 0.09 ± 0.01, respectively; all P < 0.001). HOAs within a 6-mm diameter were significantly larger in eyes with HSK (anterior surface, 1.87 ± 1.75; posterior surface, 0.42 ± 0.44; total cornea, 1.85 ± 1.46) compared with controls (0.19 ± 0.04, 0.06 ± 0.01, and 0.17 ± 0.03, respectively; all, P < 0.001). The logarithm of the minimum angle of resolution (logMAR) decreased with the corneal opacity score (0.42 ± 0.61 in grade 1, 1.30 ± 0.96 in grade 2, and 1.58 ± 0.90 in grade 3). LogMAR was significantly correlated with HOAs (R = 0.65, P < 0.0001). HOAs of the posterior surface increased from 0.15 ± 0.15 in grade 1 to 0.37 ± 0.33 in grade 3 (P = 0.005), whereas there was no difference in HOAs of the anterior surface and the total cornea among the different corneal opacity grades. CONCLUSIONS Increased HOAs of the anterior and posterior surfaces occur in eyes with corneal opacity due to HSK. Larger corneal HOAs are associated with poorer visual acuity.