An epidemic of Neisseria gonorrheae keratoconjunctivitis in African adults occurred in Malawi in 1983. Sixteen patients, seven females and nine males, aged 18 to 60 years, were admitted to the inpatient ocular services at Queen Elizabeth Central Hospital in Blantyre from 1 February to 28 May 1983, all with severe bilateral purulent keratoconjunctivitis and concomitant venereal infection secondary to N. gonorrheae. Corneal melting, corneal perforation with iris prolapse, and endophthalmitis occurred in 10 eyes, of which five required enucleation. Thirteen additional eyes sustained severe visual loss secondary to corneal ulceration, leucomata, and healed corneal perforation. The route of transmission and factors of epidemicity are speculative. Because of worldwide epidemic venereal infection ophthalmologists and epidemiologists should be alert to probable sporadic N. gonorrheae epidemics in adults. Such outbreaks could occur elsewhere, especially in the developing world, and ocular gonococcal infection might become a significant cause of irreversible blindness.