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On his 50th birthday an apparently fit man was presented with a special shirt by his regular golfing partners. In recognition of his increasing inability to follow his ball if it strayed off a line straight up the fairway, his gift was suitably inscribed. Some months later, at a routine visit to his optician, a bitemporal hemianopia was discovered. Radiological examination showed optic chiasmal compression resulting from suprasellar extension of a pituitary adenoma.[f1]
The tumour was removed via a direct transnasal transsphenoidal approach to the sella. Within a few hours of surgery his visual field defect had fully recovered on clinical testing. When he was last seen in outpatients his golf handicap had improved from 18 to 14.
As this case shows, visual symptoms resulting from lesions in the region of the optic chiasm characteristically develop insidiously,1 2 and visual defects are often advanced by the time of diagnosis of the underlying compressive cause. None the less, chiasmal decompression may be followed by dramatic and rapid visual recovery.
Contributors: Both authors managed the patient in a combined clinic, and both contributed equally to the writing of the article.
Competing interests: Neither author plays golf, but DEP owns a golfing sweater and RMR once got a hole in one.
Provenance and peer review: Not commissioned; not externally peer reviewed.