EyeTools Optometry Skills

58. Some of my patients with very poor vision tell me they have visual hallucinations. What can I do to help them?

People with vision loss sometimes experience visual hallucinations associated with Charles Bonnet Syndrome. The appearance of these hallucinations often causes anxiety for the sufferer and can be difficult for the attending eye care professional to manage.

I advise that patients with suspected Charles Bonnet Syndrome should be referred to a low vision specialist who may be able to reduce or alleviate hallucinatory activity by optimising visual function (best possible glasses and/or magnifiers or telescope), providing reassurance and information, and recommending methods that can help reduce the duration of hallucinatory periods.

Triggers are:

  • General sensory reduction.
  • A susceptible person using less than optimum refractive correction.
  • Low levels of illumination.
  • Fatigue.
  • Stress.

Stoppers are:

  • Closing or opening the eyes.
  • Blinking.
  • Putting on a light.
  • Concentrating on something else/looking for a distraction.
  • Hitting the hallucination (best done when the patient is alone or with people who understand the condition).
  • Shouting at the hallucination (best done when the patient is alone or with people who understand the condition).

If there is a self-help group in the locality the patient should be given the opportunity of attending. If these approaches fail to have a satisfactory impact on the hallucinatory activity then, in those cases where there is an operable ocular condition such as cataract, the patient could be considered for surgery, or, when this is not an appropriate option, be referred to a specialist for pharmacological therapy.




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