Abstract： Objective To retrospectively assess the clinical manifestations and treatment of secondary syphilis with ocular impairment as the initial symptom. Methods Clinical data were retrospectively analyzed on secondary syphilis with ocular impairment as the initial symptom collected from September 1998 to October 2008. Results There were 11 syphilitic patients presenting acute ocular impairment as their initial manifestation. Skin eruptions developed simultaneously with ocular impairment in 2 patients, following ocular impairment in 9 patients. All patients were positive for rapid plasma reagent test (RPR) and treponema pallidum haemagglutination assay (TPHA), but negative for HIV. Of these patients, 9 suffered from uveitis (iridocyclitis, choroiditis or panuveitis), 2 from optic neuritis; 3 had unilateral ocular involvement, 8 had bilateral ocular involvement. After treatment with injected penicillin or ceftriaxone sodium, 9 patients experienced complete visual recovery, 2 partial visual recovery. Conclusions Ocular impairment occurs in patients with secondary syphilis at a low incidence, with no characteristic clinical manifestations. For patients who have no response to conventional ocular therapy, ocular syphilis should be considered and serological examination for syphilis is recommended.