Keratohematoma leading to acquired posterior keratoconus

We describe a patient with congenital syphilis associated with corneal neovascularization and subsequent intracorneal 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 vascularization and hemorrhage secondary to congenital syphilis. We also have provided histopathologic evidence for the prescence of an iron ring.