Charles Bonnet Syndrome Management

Charles Bonnet Syndrome (CBS) is an ophthalmologic condition present in about one-third of persons with visual impairment. Patients with CBS experience various forms of visual hallucinations caused by the vision deterioration itself.

Patients with CBS have visual hallucinations without any evidence of mental illness or illicit drugs use. CBS hallucinations are out of patients’ control and can last from minutes to hours.

Although several studies have attempted to determine the biologic and environmental factors responsible for CBS, there is no strong evidence to support any specific physiologic, neurologic, or socio-environmental cause. It has been established, however, that CBS is most often experienced by geriatric persons with visual impairment, specifically age-related macular impairment.

Ophthalmologic impairments such as glaucoma, severe myopia, cataract, retinitis pigmentosa, and optic neuritis are also thought to influence the development of CBS. Medical conditions such as retinal vein occlusion, occipital infarction, and temporal arteritis are also associated with CBS.

What is the Treatment for Charles Bonnet Syndrome?

There is currently no cure or treatment for CBS. However, the condition tends to naturally regress over time at about 12 to 18 months after initial onset. During the course of illness, physicians generally advise alternative treatment to ease emotional and physical stress resulting from the condition. These secondary treatment approaches may include:

  • Vision therapy – Depending on the comorbid medical condition, a CBS patient may be advised to undergo vision therapy (low-vision rehabilitation) to decrease the physical and visual effects of the co-existing ophthalmologic condition.
  • Eye exercises – These include moving the eyes in an up-and-down or side-to-side motion. Some patients with CBS reported that engaging in eye exercises help reduce experiences of visual hallucinations.

How is Charles Bonnet Syndrome Managed?

Physicians recognize that CBS limits patients’ capacity to perform functional activities or day-to-day tasks. However, because there is no primary treatment for the condition, medical experts are left with numerous secondary treatment approaches and management strategies to reduce the presence of hallucinations.

Patients are usually advised to seek empathy and reassurance from people in their lives, especially, as they are dealing with an untreatable condition that will eventually regress after a few months. As such, patients may be asked to seek relevant psychotherapeutic interventions aimed at improving their affective and cognitive state after the onset of the condition.

On the other hand, some physicians prescribe antipsychotics, cholinesterase inhibitors, SSRIs, and antiepileptics, which reduce visual hallucinations. However, treatment is generally reserved for patients whose hallucinations become too disturbing or distressing.

Regular physician follow-ups are important to manage CBS. In doing so, both physician and patient acquire relevant information and can follow the necessary steps to manage the condition. Physicians should also advise patients to adjust their normal environmental conditions (eg, lighting, sleeping position, and ambient sounds) to externally control the appearance of visual hallucinations.

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Further Reading

Last Updated: Nov 26, 2018

Gaea Marelle Miranda

Written by

Gaea Marelle Miranda

Gaea graduated from the University of the Philippines, Manila, with a degree in Behavioral Sciences, cum laude . Majoring in psychology, sociology, and anthropology, she approaches writing with a multidisciplinary perspective.

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