Ocular surface squamous neoplasia (OSSN) is the most common neoplasm of the ocular surface, while ocular surface squamous cell carcinoma (OS-SCC) represents its invasive malignant form. In the patient in this case report, the initial symptoms were reminiscent of herpes simplex keratitis without typical signs of OS-SCC. After careful follow-up, the diagnosis was revised and the condition improved with antimetabolite therapy. At recurrence, the manifestations looked like a scleral abscess, again without the typical signs of OS-SCC. Definitive diagnosis was confirmed by surgery after pathological biopsy. The patient did not have typical clinical signs of OS-SCC in both episodes. Early treatment adjustment based on follow-up and biopsy led to a favorable prognosis.