Addressing chronic visual hallucination by multimodal retinal imaging: a CBS case

Charles Bonnet syndrome (CBS) is characterised by visual hallucinations in individuals with significant visual impairment. This literature review and case report focus on the unique presentation of CBS in an 82-year-old woman with age-related macular degeneration, who experienced visual hallucinations for over 10 years. The aim is to raise awareness of CBS among healthcare professionals and the public, addressing the diagnostic challenges that contribute to its underdiagnosis and mismanagement. A literature review was conducted to assess the prevalence and diagnosis of CBS. Databases including Google Scholar and PubMed were searched using the terms 'Charles Bonnet Syndrome', 'Case report' and 'Diagnosis'. The patient reported a range of visual hallucinations, from simple geometric shapes to highly detailed figures. A diagnosis of CBS was made based on her visual impairment and the nature of the hallucinations. No treatment was required, and the patient was reassured that the hallucinations were benign and unrelated to any psychiatric or neurological disorder. This case highlights the diagnostic challenges associated with CBS, which is often misdiagnosed or overlooked due to its rarity and the hesitancy of patients to disclose their symptoms. The long period of unreported hallucinations in this case emphasises the need for greater awareness among healthcare providers, enabling earlier recognition of CBS and differentiation from other conditions. The wide range of hallucination types seen in CBS adds to the complexity of the syndrome. The key takeaway is that increased awareness and recognition of CBS are essential for proper diagnosis, reducing patient anxiety and avoiding unnecessary treatments. This case contributes to the existing literature by illustrating the broad spectrum of CBS presentations and advocating for enhanced education on the condition.