Charles bonnet syndrome with subsequent depression in acute angle-closure glaucoma: a case report

Charles Bonnet syndrome (CBS) presents with complex visual hallucinations in visually impaired individuals with preserved insight. While most commonly associated with macular degeneration, it may occur in glaucoma. CBS is often under-reported due to stigma and may progress to psychiatric morbidity. A 63-year-old man with bilateral visual loss following acute angle-closure glaucoma experienced vivid hallucinations of animals and snakes. Initially concealed due to embarrassment, the symptoms were revealed during psychiatric assessment. Ophthalmic evaluation confirmed glaucomatous changes; MRI brain was recommended but declined. CBS was diagnosed, and hallucinations resolved with reassurance and low-dose clonazepam. Several weeks later, the patient developed moderate depression (HAM-D = 18), successfully treated with mirtazapine. At three months, he remained asymptomatic. This case is unusual for its association of CBS with angle-closure glaucoma and subsequent depression, underscoring the need for proactive inquiry, de-stigmatization, and integrated ophthalmic-psychiatric care.