The limited resolution of 3Tesla MRI often leads to missed lesions or ambiguities in the tumour environment for patients with a pituitary macro-adenoma. In this study we developed a robust high-resolution 7Tesla MRI-protocol of the optico-chiasmatic system and evaluated its clinical value. The 7T MR-images reveal tiny lesions in the optic nerve or chiasm which are not visible at 3T. These lesions could explain the vision loss for 3 of the 7 evaluated patients and gave the physician new treatment possibilities. Overall, this study shows the great clinical opportunities of 7Tesla MRI for patients with pituitary macro-adenoma or other neuro-ophthalmic conditions.