Charles Bonnet Syndrome Following Eyelid Reconstruction Surgery

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Charles Bonnet Syndrome (CBS) is characterized by the experience of complex visual hallucinations, generally in patients with partial or severe sight impairment, in the absence of cognitive impairment.1 This phenomenon is generally reported in the context of bilateral visual impairment; however, monocular visual deprivation has also been linked with CBS, particularly when the nonoccluded fellow-eye is malfunctioning. Monocular occlusion is an often neglected and underrepresented etiology of CBS. We describe a case of CBS following eyelid tumor excision surgery in a patient with normal visual acuity in the nonoccluded fellow eye.
An 89-year-old-man reported sudden onset of formed visual hallucinations within a few hours after occlusions of the left eye with pressure dressing following a left lower eyelid basal cell carcinoma re-excision/biopsy and reconstruction with direct closure under local anesthetic. The symptoms were described as complex formed patterns and shapes which persisted for several hours, but resolved completely before removal of the dressing on the next day. He denied any associated delirium, auditory hallucination, or other symptoms indicating psychosis. There was neither no past ocular or medical history of note nor any previous mental health disorders, neurologic disease, or intake of hallucinogenic, narcotic, analgesic, or new medication. He was fully oriented and aware of the false nature of his visual experience. Visual acuity was 6/12 in both eyes and ocular examination was unremarkable. Mental status assessment and neurologic examination did not reveal any abnormality. He remained asymptomatic during the subsequent 3 months follow-up period.
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