In the antibiotic era the ophthalmologist has become less familiar with the diagnosis of congenital syphilis. The recognition of this disease is crucial, as neurosyphilis or cardiovascular syphilis will develop in a substantial number of patients with latent congenital syphilis without the appropriate treatment. We describe eight patients aged 60 years or more who presented with refractive problems in whom congenital syphilis was subsequently diagnosed for the first time. One patient was found to have neurosyphilis and the highest VDRL result ever recorded by the London Public Health Laboratory. Seven patients required extensive antibiotic therapy, and three subsequently underwent successful ocular surgery. These cases illustrate the importance of recognizing this treatable disease.