ABSTRACT
Introduction: Charles Bonnet syndrome (CBS) is a condition that causes visual hallucinations in patients without any mental illnesses. CBS is characterized by the presence of vivid, complex and recurrent visual hallucinations, and do not occur in the setting or as part of delirium or other psychological illnesses. The condition is present in patients who have visual loss due to age-related macular degeneration (AMD), cataracts and/or other ocular diseases that influence vision. Case report: A 81-year-od woman reported to ophthalmologist complaining of visual hallucinations that consisted of white pigeons. Hallucinations were present for two years and she was well aware that hallucinations were unreal. Mental illnesses were excluded by the psychiatrist. Complete ophthalmologic examination was performed, and finding revealed visual acuity of 0.3 (right eye) and 0.5 (left eye), in both eyes cataracts and AMD (wet form). Optical coherence tomography confirmed the fundoscopic finding of AMD. The patient rejected treatment of cataracts and AMD due to old age, and hallucinations persisted. Conclusion: CBS should be considered in patients with visual hallucinations and ocular diseases that influence vision. It is essential to distinguish CBS from mental illnesses, since patients with CBS are fully aware that hallucinations are not real. Awareness of CBS could help physicians upon referring patients to ophthalmologists instead of psychiatrists, and therefore avoid patients being misdiagnosed.
Subject(s)
Cataract/complications , Charles Bonnet Syndrome/etiology , Macular Degeneration/complications , Aged, 80 and over , Cataract/diagnosis , Cataract/physiopathology , Charles Bonnet Syndrome/diagnosis , Charles Bonnet Syndrome/physiopathology , Charles Bonnet Syndrome/psychology , Diagnosis, Differential , Female , Humans , Macular Degeneration/diagnosis , Macular Degeneration/physiopathology , Predictive Value of Tests , Tomography, Optical Coherence , Treatment Refusal , Visual Acuity , Visual PerceptionABSTRACT
BACKGROUND/AIM: It is known that glaucoma is associated with elevated intraocular pressure and obesity, yet the precise etiology remains unclear. The aim of this study was to determine whether there is a potential causality between the volume of retrobulbar adipose tissue and the level of intraocular pressure in obese subjects compared with non-obese. METHODS: A total of 100 subjects were divided according to the body mass index (BMI), into two groups: normal weight (n = 50, BMI = 18-24.9 kg/m2) and obese (n = 50, BMI > or = 30 kg/m2) subjects. Anthropometric measurements, body composition analysis, measurement of intraocular pressure, as well as magnetic resonance imaging (MRI) of the head at the level of the optic nerve, and the derived retrobulbar adipose tissue volume, were undertaken in all subjects. RESULTS: The obese subjects, as compared with normal weight ones, had a significantly higher mean retrobulbar adipose tissue volume (6.23 cm3 vs 4.85 cm3, p < 0.01) and intraocular pressure (15.96 mmHg vs 12.99 mmHg, p < 0.01). Furthermore, intraocular pressure correlated positively with retrobulbar adipose tissue volume. CONCLUSION: In obese people, elevated intraocular pressure may be caused by changes in ocular blood flow, affected by the physical pressure exerted by higher retrobulbar adiposity, and/or by internal vascular changes secondary to complications of obesity. These findings indicate the need for more frequent measurement of intraocular pressure in obese individuals to earlier detect glaucoma, and in so doing prevent irreversible blindness.
