MicroRNAs (miRNAs), the newly discovered regulators of gene expression, act by promoting degradation of mRNA and/or by inhibiting protein expression. Dysregulation of miRNA expression has been noted in an expanding number of diseases; and in some instances, manipulating miRNA expression holds promise as a new form of therapy. Herpetic stromal keratitis (HSK) is an important vision-impairing lesion and currently any role that miRNA dysregulation plays during its pathogenesis is only just beginning to be investigated. In this review, we discuss the likely participation of specific miRNAs during HSK and discuss the prospect of modulating their expression as a means of therapy.