We describe a patient with congenital syphilis associated with corneal neovascularization and subsequent intra-corneal hemorrhage. Over time, this condition resulted in acquired posterior keratoconus. A review of our clinical case, the literature, and histologic findings is presented. To our knowledge, this is the first reported case of acquired posterior keratoconus associated with corneal vas-cularization and hemorrhage secondary to congenital syphilis. We also have provided histopathologic evidence for the prescence of an iron ring.