Sir,

Pituitary macroadenomas (ie tumour >5 mm) can extend in either lateral, superior, posterior, inferior, or more seldom anterior directions, thus invading the orbital cavity through the optic foramen and/or the superior orbital fissure. Orbital invasion by pituitary adenoma has been previously described, but is a rare growth pattern of this tumour.1,2,3,4,5,6,7,8,9,10,11 Visual loss is a frequent symptom of orbital extension of a pituitary macroadenoma, other signs and symptoms including diplopia, orbital pain, and exophthalmos. Therapeutic options include surgical removal or irradiation of the tumour, but visual outcome is usually poor, and final visual acuity is frequently no better than finger counting.

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