Purpose

Charles Bonnet syndrome (CBS) is characterized by the occurrence of complex visual hallucinations in cognitively intact individuals with visual impairment, accompanied by preserved insight into the unreal nature of the percepts. The syndrome is relatively common among ophthalmic patients, with reduced visual acuity, bilateral visual loss, and advanced age recognized as established risk factors. Recent meta-analysis suggests that approximately one in five to six patients with retinal disease, glaucoma, or low vision may experience CBS.
The existing literature has largely focused on reports of Charles Bonnet syndrome in patients with ophthalmic conditions associated with marked visual impairment. In contrast, individuals presenting with conditions such as eyelid ptosis, chalazion or other disorders that do not typically result in severe vision loss have only infrequently been described in association with CBS, primarily in isolated case reports and small case series.

---

Methods

We describe the clinical course of an 81-year-old man who developed acute-onset formed visual hallucinations consistent with CBS in the setting of postoperative eyelid closure due to blepharospasm following ptosis repair surgery. The hallucinations stopped within three days after treatment with botulinum toxin type A, concomitant with improved eyelid opening.

---

Results

This case represents an atypical presentation of Charles Bonnet syndrome (CBS) occurring in the immediate postoperative period, associated with transient visual deprivation due to severe blepharospasm following ptosis repair.

---

Conclusion

CBS has been described in association with a range of conditions causing reduced visual input. To our knowledge, postoperative blepharospasm resulting in transient functional visual deprivation has not been previously reported as a precipitating factor. Recognition of this mechanism may facilitate differentiation of CBS from other postoperative hallucinations and emphasize restoration of visual input, with patient reassurance as a central component of management.

---

Additional Authors

First name	Last name	Base Hospital / Institution
Arie	Nemet	Meir Medical Center

↑ Back to top