Discovering a dys-covering lid

A patient with a large pituitary adenoma presenting with signs of primary aberrant regeneration of the left oculomotor nerve is reported. The proposed pathophysiological mechanisms involved in this syndrome are discussed and the known lesions causing it are listed. The various presentations of a pituitary adenoma, common and less common, are reviewed. Although neuroimaging is readily available, predicting the site of the lesion based on a meticulous clinical examination remains a challenge for ophthalmologists.