A case of acute reversible Charles Bonnet syndrome following postsurgical unilateral eye patch placement.
A fully alert 70-year-old male with no significant medical or psychiatric history presented for surgical follow-up after uncomplicated right lower eyelid cicatricial ectropion surgery with postoperative unilateral, eye patch placement complaining of visual hallucinations. Preoperative unaided visual acuity was 20/20 in each eye. The patient described simple, nonformed and complex, formed images that were both static and animated. The images included crystal-like formations that appeared to bubble, green leaves against a vivid magenta backdrop, and an isolated hallucination of a lifelike plant with trembling leaves. These hallucinations began 2 days postoperatively and persisted 2 days following eye patch removal. The patient perceived the hallucinations multiple times a day over the 7-day period, without a stereotyped pattern. The images occurred when the eyes were open and ceased when they were closed. They were prompted by looking at a blank wall or white surface. The patient consistently recognized these images as unreal. They typically persisted for 1 to 2 minutes and could be extinguished by looking away. There were no associated auditory hallucinations, psychosis, or delirium and no history of visual, cognitive, or neurological deficit. The patient denied the use of hallucinogenic medications, including analgesics, or the initiation of any new medications. To the authors' knowledge, this is the first reported case of acute reversible CBS following unilateral eye patch placement. CBS may be a frightening postsurgical consequence of eye patch placement. It is important that the ophthalmic surgeon be aware of the potential for development of CBS and offer appropriate referral and reassurance should it occur.
Khadavi
Nicole Miriam
NM
David Geffen School of Medicine at UCLA, Department of Ophthalmology, Jules Stein Eye Institute, Los Angeles, California 90095, USA.
Lew
Helen
H
Goldberg
Robert Alan
RA
Mancini
Ronald
R
D000208:Acute Disease; D000368:Aged; D001458:Bandages; D004483:Ectropion / Q000601:surgery*; D006212:Hallucinations / Q000175:diagnosis / Q000209:etiology*; D006801:Humans; D008297:Male; D011183:Postoperative Complications; D013577:Syndrome; D014786:Vision Disorders / Q000175:diagnosis / Q000209:etiology*; D014792:Visual Acuity