Optic disc oedema (ODE) due to syphilis without visual compromise has been primarily attributed to papilloedema from raised intracranial pressure or optic perineuritis from optic nerve sheath inflammation. These terms were proposed before magnetic resonance imaging (MRI) was largely available. The authors present four retrospective chart review cases of unilateral ODE due to serology-positive syphilis with normal visual function, normal intracranial pressure and no MRI enhancement of the optic nerve sheath. Authors propose the term ‘incipient syphilitic papillitis’ for cases presenting with ODE, preserved vision and the absence of optic nerve sheath enhancement, which they propose as a more common presentation than syphilitic optic perineuritis. An algorithmic approach to ODE from neurosyphilis is proposed, to include MRI in elucidating the underlying anatomical region of the anterior visual pathway.