Charles Bonnet syndrome: are medications necessary?

Charles Bonnet syndrome (CBS) is a clinical entity in which patients develop vivid visual hallucinations in the absence of psychiatric illness. In the great majority of cases, a decline in visual acuity precedes the development of CBS. The patient maintains intact reality testing and recognizes that the hallucinations are not real. There is no definitive cure for CBS, although various pharmacologic agents, behavioral strategies, and ophthalmologic interventions have been used in an attempt to reduce or relieve symptoms. We present the case of a 79-year-old man who presented with the onset of vivid visual hallucinations after developing cataracts. We also review previous case reports of CBS and discuss treatment options.