Types of Images seen in Charles Bonnet Syndrome

Charles Bonnet syndrome (CBS) can cause vivid visual hallucinations in people with impaired vision while insight and other senses remain largely intact. Images may be simple or complex, static or moving, pleasant, confusing, or frightening. Education and reassurance can reduce distress; clinicians and caregivers should also assess fall risk, orientation, toileting, and unsafe responses to perceived hazards.

360-Degree or Panoramic Scenes

Immersive scenes can fill the entire visual field and create the impression of being in another location. A home may seem replaced or rearranged, causing disorientation, difficulty finding the bathroom, and increased fall risk.

Animals and Insects

Domestic or wild animals may appear indoors or outside, sometimes unusually sized or fantastical. Snakes, spiders, ants, and perceived insects or worms in food or on skin can provoke hazardous responses such as unnecessary pesticide use.

Buildings, Construction, and Plants

Buildings, work crews, fences, graves, trees, forests, or jungles may overlay familiar surroundings. These images can alter perceived routes and create confusion during walking or travel.

Cartoons and Animations

Cartoon-like figures may appear in black and white or color. They may be static, intermittently changing, or fully animated; familiar media characters are possible but uncommon.

Cliffs, Holes, and Precipices

Cliffs, ledges, or holes may appear indoors or outdoors without a realistic setting. These perceptions are often frightening and should prompt attention to mobility and fall prevention.

Color Washes and Bright Light

Color may appear as a transparent or opaque mist, fog, or veil. It can obscure residual vision or fill the visual field. Bright light may be irritating and fatiguing.

Metamorphopsia and Distortions

Faces, bodies, or objects may appear enlarged, reduced, incomplete, or fused with unrelated features. Distortion can make otherwise ordinary images unsettling.

Oscillopsia and Apparent Movement

A person may feel continued motion after a vehicle stops, or may perceive stationary furniture and surroundings as moving.

Patterns

Wallpaper, brickwork, tiled floors, checkerboards, geometric forms, and spiderweb-like designs may cover walls, ceilings, floors, or outdoor spaces and interfere with navigation.

People and Humanoid Figures

Unfamiliar people are often among the most distressing CBS images and may feel like intruders. Figures may be silent, expressionless, oddly dressed, incomplete, distorted, tiny, still, or moving. They may seem to gesture, touch real objects, emerge through walls, or interact with others, although no physical interaction occurs.

Repetition and Persistence

Identical images may repeat across the visual environment. Images can also persist after a person turns or moves, sometimes remaining at a fixed distance while appearing to travel with them.

Text and Symbols

Words, numbers, musical notation, and other symbols may appear on almost any surface. Content is usually brief, changing, difficult to read, and without meaningful personal relevance.

Unformed Images

Amorphous shapes, textures, changing colors, flashes, or fields of bright light may float within or fill the visual field.

Response to Images

Validate the experience without confirming the image as real. Explain that CBS is associated with visual loss, encourage the person to describe triggers and patterns, and optimize lighting and visual function. Review medications and medical status when appropriate. New hallucinations, loss of insight, confusion, auditory symptoms, neurological changes, or sudden worsening warrant clinical evaluation. Immediate hazards—including falls, wandering, unsafe driving, or attempts to fight, spray, avoid, or step around images—require a practical safety plan and caregiver support.