What are visual hallucinations?
A visual hallucination is the perception of a visual image that is not the result of seeing an object outside the eye. Normally, the eye perceives light from objects outside the eye and sends the image to the brain for interpretation. However, there are a number of circumstances that result in images being “seen” by a patient that do not originate from outside the eye. These images are referred to as hallucinations, especially if they appear as formed images of recognizable objects, like faces, trees, or other familiar things. Sometimes, hallucinations appear as dots, lines, or geometric shapes. The hallucinations may be in color or black and white.
What causes hallucinations?
A large list of problems may cause visual hallucinations. These include drug use and abuse, delirium, mental illness, and a variety of neurological conditions (including stroke, multiple sclerosis, and dementia). Sometimes, eye disease causes visual hallucinations; this is called the Charles Bonnet syndrome. It is a common condition in which the brain “makes up images” as a result of loss of vision from an eye condition (such as macular degeneration, diabetic retinopathy, or glaucoma). Charles Bonnet was an 18th century botanist and philosopher who described complex visual hallucinations in his grandfather after loss of vision.
How can a doctor find the underlying cause of visual hallucinations?
A doctor may determine the cause of visual hallucinations by careful examination and testing. If the hallucinations are interpreted by the patient as being “real,” the cause is more likely related to mental illness or may be due to drug intoxication or neurological disease. In these cases, the mental status exam is usually not normal. In the Charles Bonnet syndrome, the patient knows what he is seeing is not real, but sees the images nonetheless. An eye exam may make the diagnosis, but in some cases, further testing is needed. And these may include blood tests and imaging studies (CT scan and/or MRI brain scan). The final diagnosis of Charles Bonnet syndrome is made only after other more serious diagnoses are excluded.
What is the treatment of visual hallucinations?
The treatment depends on the underlying cause. In the case of the Charles Bonnet syndrome,
counseling may help. Much relief comes from knowing that the symptoms are benign and do not represent a serious medical condition. Some patients find the symptoms improve if they move their eyes up-and-down, or left-and-right, or look away from the hallucinations. Others find it helps to stare at the hallucination until it fades away. It may help to talk about the hallucination with a family member or friend. Because stress and fatigue may precipitate the hallucinations, some recommend getting plenty of sleep and rest. Exercise and meditation are helpful. Thankfully, the visual hallucinations from Charles Bonnet syndrome often subside with time and may disappear over months to years. Rarely, medication may be prescribed by a neurologist. New treatments are on the horizon.
Related blog: The Visual Snow Syndrome
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