Charles Bonnet Syndrome in patient with advanced glaucomatou
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An 86 year old female patient with primary open-angle glaucoma (POAG), senile incipient cataract, and arterial hypertension. She had no history of head trauma.

The BCVA in the right eye was 0.8 and 0.5 in the left eye. Both eyes showed advanced concentric VFD with only small central apertures left. The MD was -28.53 dB and VFI 13% in the right eye. The MD in the left eye was -30.27 and VFI 4%. The OCT revealed subfoveal neurosensory detachment in the right eye and drusenoid maculopathy in the left eye.

The patient had undergone SLT treatment in her right eye previously and was on two-substance OHD for her glaucoma. She reported seeing a woman with long boots walking in front of her. She first experienced this hallucination while taking a walk with her husband. She mentioned telling her husband, how strange it was that the woman had been walking in front of them all the time but found out that her husband did not see any woman in front of them.

The patient also reported seeing the face of a monkey, placed on her grandchild’s face, sitting on the sofa in front of her. Other visual hallucinations that the patient reported consisted of an unknown man in a trench coat. The patient also experienced hallucinations consisting of small colourful duvets with grape and clover prints. These hallucinations lasted for many hours during the day, occurring both in and outdoors, which was disturbing for the patient.

She reported having these hallucinations (the woman in long boots and the face of a monkey) for 5 months until they disappeared. However, some of the hallucinations could be transient and intermittent, and they decreased or disappeared during the winter and came back around April when it got lighter. The patient had been experiencing this sporadic reappearance of hallucinations for 3 years in a row. For instance, she had been recently experiencing the hallucination of the man in the black trench coat walking in front of her.