Purpose: We report a case of corneal perforation during intravitreal Faricimab injection for neovascular age-related macular degeneration (nAMD) in a patient with a history of herpetic keratitis.Case summary: A 78-year-old male with a history of bilateral herpetic keratitis presented with corneal opacity in the right eye and a history of penetrating keratoplasty in the left eye. During follow-up, he reported sudden visual deterioration in the right eye. Although the corneal status remained stable, optical coherence tomography and indocyanine green angiography revealed nAMD in the right eye.The patient was treated with intravitreal Faricimab injections. Approximately one month after the second injection, the patient presented again with sudden visual loss in the right eye. Slit-lamp examination demonstrated a geographic corneal ulcer, corneal perforation, and anterior chamber collapse, necessitating permanent amniotic membrane transplantation. Conclusions This case suggests that intravitreal Faricimab triggered herpes virus reactivation in a patient with a history of herpetic keratitis, resulting in corneal perforation. Careful monitoring is essential when administering anti-VEGF therapy in patients with prior viral keratitis, particularly those with pre-existing corneal thinning. As no previous cases of herpes reactivation and corneal perforation related to Faricimab have been reported, this highlights the need for further investigation and preventive strategies in high-risk patients.