Charles Bonnet Syndrome: Cause of Visual Hallucinations In the Elderly

July 13, 2009

I just wrote an article on my blog regarding visual hallucinations. Once in a while, patients that have become legally blind, or worse, may “complain” about randomly “seeing” images in perfect detail. Many times these patients are very concerned about losing their mind. The family, too, is concerned, fearing that dear old mom or dad is becoming demented. This is not necessarily true.

This may be a manifestation of the Charles Bonnet Syndrome (CBS). It usually affects patients that once could see well, but now are rendered with severe vision loss. In my experience, these are usually people with advanced macular degeneration.

CBS is not well understood. While I don’t know the exact cause, I liken these hallucinations to a type of visual sensory deprivation. The brain is smart and know it should “see” in much better detail than it does. It creates these images to provide sufficient “visual” stimuli. I also use the analogy of phantom pain in people suffering the loss of a limb.

CBS patients are usually completely oriented, coherent and intelligent. They present to the office fearful of going crazy. They are smart enough to know this doesn’t make sense. While there are many other reasons that may cause similar symptoms, there may be a plausible, happier explanation.

Randall V. Wong, M.D.
Retinal Specialist




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2 Responses to “Charles Bonnet Syndrome: Cause of Visual Hallucinations In the Elderly”

  • Hm. Sounds a little suspicious to be honest. I would be concerned that there may be some dementia.

    CBS has typically been reported as images of nice calm subjects; flowers, children, smiling faces etc.

    I’d run it by his doctor.

    Randall V. Wong, M.D.

  • Tony Perino

    My 92 year old father-in-law has advanced macular degeneration, is confined to a motorized wheel chair and has worn a body hearing aid for many years. He currently lives in an assisted living center. He has been complaining of repeated visits by “a women in black with two children who live in his shower. They turn on the TV. The children climb the walls by his bed. And…yesterday, the women climbed into bed with him and tried to take off his diaper. Just thought you’ld like to have a real life example.