The eyes have it! Visual hallucinations with facial distortions during delirium

Recurrent complex visual hallucinations (RCVH), particularly of people, are common during delirium and in dementia, especially Lewy body disease, and acquired eye disease. Studies in those with acquired eye disease suggest that facial distortions, with exaggerated eyes and mouths, are a common feature. We report, and discuss the possible mechanism, of two examples of similar facial distortions in hallucinations occurring during delirium, including one where the patient was able to draw what he experienced. The hallucinations in this report are consistent with the Perception and Attention Deficit model for RCVH and suggest that in delirium, where attentiveness is reduced, the eyes and mouth may receive much of the available attentional focus resulting in hallucinated faces with exaggeration of these features.