Craniopharyngiomas are benign sellar and suprasellar tumors that originate in the region of the posterior pituitary, and represent embryonic remnants of Rathke's pouch. Their occurrence in adults is rather rare, accounting for only 3% of all intracranial neoplasms, and 20% of all suprasellar tumors. Prolonged compression of the optic nerve or chiasm by a craniopharyngioma can lead to irreversible vision loss. The visual prognosis is poor in adults over 40 years old who present with severe vision loss and optic atrophy in the involved eye. The case of a 55 year old black female, who came in with the chief complaints of decreased vision in the right eye and brow ache over the right eye will be presented. The clinical and ocular signs, diagnostic findings (including visual fields, VEP and MRI), management and post-surgical visual prognosis of adults with craniopharyngiomas will be discussed. This case emphasizes the importance of including craniopharyngiomas in the differential diagnosis of decreased vision with optic atrophy because early detection and surgical intervention may prevent severe vision loss.