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Insights
Charles Bonnet syndrome (CBS) causes visual hallucinations in individuals with vision loss from eye conditions like AMD and cataracts. Recognizing CBS helps avoid misdiagnosis, distinguishing it from mental illness.
Area of Science:
- Ophthalmology
- Neurology
Background:
- Charles Bonnet syndrome (CBS) involves visual hallucinations in individuals with no psychiatric disorders.
- CBS is linked to vision impairment from conditions such as age-related macular degeneration (AMD) and cataracts.
Observation:
- An 81-year-old woman experienced persistent visual hallucinations of white pigeons for two years.
- Ophthalmologic examination revealed reduced visual acuity, cataracts, and wet AMD in both eyes.
Findings:
- The patient was aware her hallucinations were unreal, and psychiatric evaluation ruled out mental illness.
- Despite AMD and cataracts, the patient declined treatment, and hallucinations continued.
Implications:
- CBS should be suspected in patients with visual hallucinations and co-existing ocular diseases.
- Differentiating CBS from psychiatric conditions is crucial for accurate diagnosis and appropriate referral to ophthalmologists.
Introduction:
Charles Bonnet syndrome (CBS) is a condition that causes visual hallucinations in patients without any mental illnesses. CBS is characterized by the presence of vivid, complex and recurrent visual hallucinations, and do not occur in the setting or as part of delirium or other psychological illnesses. The condition is present in patients who have visual loss due to age-related macular degeneration (AMD), cataracts and/or other ocular diseases that influence vision.
Case Report:
A 81-year-od woman reported to ophthalmologist complaining of visual hallucinations that consisted of white pigeons. Hallucinations were present for two years and she was well aware that hallucinations were unreal. Mental illnesses were excluded by the psychiatrist. Complete ophthalmologic examination was performed, and finding revealed visual acuity of 0.3 (right eye) and 0.5 (left eye), in both eyes cataracts and AMD (wet form). Optical coherence tomography confirmed the fundoscopic finding of AMD. The patient rejected treatment of cataracts and AMD due to old age, and hallucinations persisted.
Conclusion:
CBS should be considered in patients with visual hallucinations and ocular diseases that influence vision. It is essential to distinguish CBS from mental illnesses, since patients with CBS are fully aware that hallucinations are not real. Awareness of CBS could help physicians upon referring patients to ophthalmologists instead of psychiatrists, and therefore avoid patients being misdiagnosed.
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