Charles Bonnet Syndrome (Visual Release Hallucinations)

Charles Bonnet syndrome (CBS) is a condition that happens after you develop low vision. It makes you experience visual hallucinations. Healthcare providers also call it experiencing visual release hallucinations.

A hallucination is something you sense that seems real, but isn’t. Other people around you won’t see or experience it. If you have visual release hallucinations, your brain creates images that aren’t coming from your eyes. Visual release hallucinations aren’t related to psychiatric conditions.

Visual release hallucinations can be simple, like bright-colored patterns that show up over everything you see (unformed hallucinations). You might also see more complex images, like animals, buildings or people that don’t exist (formed hallucinations).

You’ll probably know the images aren’t real. Even if you can tell the hallucinations aren’t really there, they can still make you feel stressed or upset. The hallucinations shouldn’t speak to you or touch you.

Symptoms of Charles Bonnet syndrome

Seeing visual release hallucinations is the main CBS symptom. Some examples include:

• Imaginary or fantasy animals: This includes seeing fictional creatures like dragons, unicorns or monsters from a movie.
• Nature scenes: You might see waterfalls, trees, mountains, bugs or a park scene.
• People or animals you know: You can see faces of loved ones, coworkers or neighbors from your past or present. Some people see pets or other animals.
• Repeated patterns: You might see a brick wall, netting, a web or another grid-like pattern that repeats the same shape and lines.

No matter what you see, the hallucinations may be:

• Clearer and more vivid when your eyes are open (closing your eyes may make images cloudy or harder to “see”)
• In color or black-and-white
• Silent (they won’t make you hear any unusual sounds)
• Still images (static) or moving pictures like a TV show

You may see the same image or scene each time, but some people see something different each time they experience visual release hallucinations.

Charles Bonnet syndrome causes

Losing some or all of your vision causes CBS. Experts think it happens when your brain tries to fill in the gaps after you experience vision loss.

Usually, your retina converts light into a visual signal for your brain. If you have low vision, your eyes can’t transmit as much information to your brain as it’s used to. When this happens, your brain may try completing the picture on its own. It may use your memories or make up new images.

Conditions related to developing Charles Bonnet syndrome include:

• Age-related macular degeneration
• Stroke
• Cataracts
• Glaucoma
• Retinitis pigmentosa
• Diabetes-related retinopathy
• Optic neuritis
• Giant cell arteritis
• Eye removal (enucleation or evisceration)

Remember, a psychiatric condition doesn’t cause these hallucinations.

Risk factors

Your risk of visual release hallucinations increases as you age. Up to half of people with low vision experience CBS at some point. But it usually happens after age 80.

You may be more likely to develop Charles Bonnet syndrome if you live alone or aren’t socially connected to many people. Spending a lot of time in the dark (indoors with natural light blocked out) may increase your risk, too.

How doctors diagnose visual release hallucinations

A healthcare provider or eye care specialist will diagnose the hallucinations with a physical exam and a complete eye exam. They’ll ask about your medical history. Tell your provider when you first experienced a hallucination and if you know you have any eye conditions that reduce your vision.

Tell your provider if you’ve recently had eye surgery or started a new medication. Hallucinations can be a temporary side effect.

Tests that are used

Your provider may give you a neurological exam or use imaging tests like an MRI or CT scan to rule out other issues that can cause hallucinations. Other conditions that can cause similar symptoms include:

• Alzheimer’s disease
• Drug and alcohol withdrawal
• Lewy body dementia
• Parkinson’s disease
• Schizophrenia

Charles Bonnet syndrome treatment

There aren’t any treatments that can cure or prevent CBS. Fortunately, many people have fewer hallucinations (or stop having them completely) once their brain and eyes adjust to having reduced vision. This adjustment period usually takes a year or two.

Your healthcare provider can suggest ways to manage the hallucinations. These aren’t treatments to stop visual release hallucinations, but they can help your brain adjust. Your provider may recommend:

• Adding lighting: Spending more time in brightly lit environments can help reduce how often you experience CBS. Opening the blinds or curtains during the day, or turning on an extra lamp or two at night, can help.
• Getting plenty of sleep and managing stress: Resting and relaxing are important to your overall health. And getting a healthy amount of sleep is one of the best ways to support your mental health. Your provider may suggest relaxation techniques, like meditation or breathing exercises.
• Intentional eye movements: Blinking your eyes may help dismiss a hallucination. Moving your eyes to focus on something else can help, too. Even if you know the image isn’t real, not looking at it can take your brain’s attention off it.
• Medications: There aren’t any medications that treat CBS, but your provider may prescribe anti-anxiety medications or antidepressants if the hallucinations affect your mental health.
• Staying socially connected: Spending time with loved ones can help keep your brain active and engaged. This can help you feel less isolated. Your provider may be able to recommend a support group where you can connect with others who have CBS.

When should I see my healthcare provider?

Visit a healthcare provider or eye care specialist as soon as you notice any changes in your eyes or vision. The sooner you get the underlying cause of CBS diagnosed, the better. Tell your provider if you’re having more (or more intense) visual release hallucinations. They may be able to suggest other ways to help manage them.

What can I expect if I have Charles Bonnet syndrome?

You might have to manage CBS for a while. It may disappear over time, but it can take a year or two to go away.

You may find it difficult to do some of your daily tasks or move around in places you don’t know well if you’re experiencing hallucinations. Don’t be afraid to ask for help from your healthcare provider or trusted loved ones. They can help you get any support and accommodations you need to do all your favorite activities.