The authors present a case of severe gonococcal conjunctivitis associated with corneal perforation of the right eye in a 25-year-old homosexual man. Inpatient management and corneal grafting were required. The authors demonstrate that Neisseria gonorrhoea should be considered in the presence of purulent conjunctival discharge with a white patch on the cornea or reduced vision. Regardless of whether a patient has genital symptoms, they should be referred urgently to an ophthalmologist to ensure adequate treatment of this rare but sight-threatening complication.