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Posted: November 29, 2008

Charles Bonnet Syndrome

Hallucinations, Visions and Vision Impairment Among Elderly

When a seemingly physically and mentally healthy person begins having hallucinations, it can become unnerving for caregivers, and sometimes the patient. However, hallucinations – basically seeing things that aren't there -- aren't always a symptom of illness or dementia.

Some people with serious visual impairments, such as macular degeneration, cataracts, or other damage to the optic nerve, can experience vivid "phantom visions." This is called "Charles Bonnet Syndrome," after the 18th century Swiss scientist who first described these phantom visions, or hallucinations, when he began to lose his own vision.

These "visions" are often described as being similar to the pain that amputees feel in a missing limb. The brain interprets signals from the remaining nerve endings as “feeling” in the missing part. Similarly, if the cells in the retina no longer receive visual images, the vision system may begin creating and sending its own images to the brain.

According to the available research, Charles Bonnet syndrome affects up to 40% of people with visual impairment. Quoting Mogk & Mogk in their book Macular Degeneration: The Complete Guide to Saving and Maximizing Your Sight, "Patients have reported seeing cartoon characters, flowers in the bathroom sink, hands rubbing each other, waterfalls and mountains, tigers, maple trees in vibrant autumn foliage, yellow polka dots, row houses, a dinner party and brightly colored balloons. Many people see faces or life-size figures that they've never seen before. One of the most remarkable qualities of these figures is that they almost always wear pleasant expressions and often make eye contact with the viewer."

While it is important for caregivers (and physicians) to recognize, there is no specific medical treatment for Charles Bonnet Syndrome. Some people find that the frequency of these hallucinations does subside over time.

Although most people with Charles Bonnet Syndrome do not find their visions to be disturbing, a person who is also suffering from a dementia may find their ability to distinguish what is real from what is not is also impaired. In this case, the visions may be very disturbing.
If your elder has a vision impairment and is "seeing things," and if you have ruled out medications and a sudden onset of a physical illness (including always checking for a urinary tract infection), before you consider psychiatric drugs, you may want to consult with an ophthalmologist who is familiar with Charles Bonnet Syndrome.


Molly Shomer is a family caregiving specialist and licensed geriatric care manager. She is a nationally recognized expert on eldercare issues and the author of The Insider's Guide to Assisted Living. Her website is, and she can be reached at

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