Abstract : <p> 25 year old male, working as a mechanic presented to the ophthalmology OPD with complaints of painless diminution of vision since 15 days. He had no other ocular symptoms and was a known case of schizophrenia maintaining well on psychotropic medication. His family history was not significant and no high risk behaviour was seen. Ocular examination showed a vision of 6/60 (OD) and Hand Movements (OS) with features of Neuroretinitis in OU fundus. His routine lab investigations were within normal limits, with a negative VDRL but 1:160 titres on TPHA in serum and 1:80 in CSF. Patient was diagnosed as a case of neurosyphilis and treated for the same with remarkable improvement in ocular symptoms with vision 6/9 (OD) and 6/36 (OS) after 2 weeks. Due to the high risk and an aggressive presentation of behavioural symptoms the department of psychiatry decided against discontinuing there medications. Patient reports to be doing well and is on regular follow up.</p> <p>Neurosyphilis is a tertiary manifestation of Syphilis which can present as neurological, behavioural and ocular  signs. Several studies  have reported a shift in the trend of clinical manifestations of the disease in the recent past. Psychiatric symptoms may range from mood features, dementia or delirium and psychosis. Ocular syphilis with an incidence of 0.65% can involve any part of the eye leading to an inflammatory response. Of these neuroretinitis is a rare complication with risk of loss of vision. As psychiatric symptoms can be the presenting manifestation in patients of syphilis, intervention can be delayed leading to further systemic involvement.</p>