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Herpes zoster oticus (HZO) is a viral infection of the ear. Most patients with Herpes zoster oticus have diverse symptoms associated with dysfunction of the 7th and 8th cranial nerves. Ocular nervous system lesions can also be involved by herpes zoster, but isolated trochlear nerve lesion involvement is extremely rare. We discriminate other possible factors causing isolated trochlear nerve palsy and found a clear improvement of vertical diplopia after use of antiviral agent without systemic steroid. We report a case of delayed trochlear nerve palsy induced by Herpes zoster oticus in a 69-year-old male with a review of the literature.