Charles Bonnet syndrome (CBS) is characterized by the presence of visual hallucinations without other sensory-perceptual disturbances or evidence of organic mental disorder nor functional psychosis.

Review differential diagnosis of BCS, searching articles in Pubmed.

62-year-old woman, undergoing treatment with Sertraline and psychotherapy for three months because of anxious-depressive synthoms. Pathological myopia and retinal detachment in 2012, blind left eye, retaining 33% vision in the right eye. She comes to the emergency room feeling really anxious, she says that for a year now she has had the feeling that her husband is cheating on her with another woman, and she claims with certainty that she sees a woman in her bed at night, as well as flashes of light evidencing her presence. She has also begun to hear voices through the telephone wires. She and her family deny memory loss or other cognitive impairments. We performed a Nuclear Magnetic Resonance with normal results. Family claims good conygal relation until these synthoms began and no signs of cognitive impairment.

The patient lives as real these hallucinations which haven´t appeared during admission. We started treatment with an antipsychotic and a benzodiazepine, with great improvement of anxiety and development of some insight. Executive impairment was observed.

The results obtained, make us think that, although our patient has an important visual loss, it is more a psychiatric pathology. Here lies the importance of a multidisciplinary approach among ophthalmologists, neurologists and psychiatrists in order to avoid misdiagnosis and that the patient can benefit from proper treatment.

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Faced with recent onset psychotic symptoms in patients over 60 years of age without a psychiatric history, it is important to carry out an adequate differential diagnosis.

The objective is to carry out a review of Charles Bonnet syndrome through the presentation of a case

75-year-old patient who suddenly began to present auditory hallucinations. The patient had no relevant psychiatric history or medical history. She reported that suddenly, two months ago, she had begun to listen to his neighbor through the walls of his home. She heard him talk about her, threatening and insulting her. Later, as a result of these hallucinations, she began to believe that in the bathroom he was spying on her through a camera, forcing her to shower in the dark. Weeks later, she thought that he was also chasing her down the street through a chip that had implanted her. She was distressed and highly anxious. She had started not sleeping out of fear of this neighbor.

In addition to the psychiatric evaluation, an MRI was requested to rule out incipient cognitive deterioration, as well as a hearing examination. It was found that he had severe hearing loss in the left ear. Given these findings, he was diagnosed with Charles Bonnet syndrome.

Charles Bonnet syndrome is normally associated with blindness, however, it is also described in deafness. It occurs with hallucinations of the lost sensory organ. It is a clinical picture that does not respond well to treatments.

No significant relationships.

Charles Bonnet syndrome (CBS) is characterized by the presence of visual hallucinations, generally complex, which occurs in patients with alterations in the visual pathway. The majority of affected patients are elderly. It appears in 15% of people with visual loss, predominantly in the 80-year-old female gender.

To present a clinical case of a patient with visual hallucinations and a possible diagnosis of Charles Bonnet syndrome. Highlight the importance of an adequate differential diagnosis.

Bibliographic review of the treatment and diagnosis of CBS, from articles published in the last 5 years in Pubmed.

Woman, 80 years old. No ophthalmological history except those associated with advanced age. She goes to the emergency room due to the presence of visual hallucinosis, in the form of “television presenters” of whom she makes partial criticism, being aware most of the time of their unreality. Hallucinations are not accompanied by anxiety or significant affective repercussions. Discarded delirium, intoxication by substances or drugs that cause the condition. Currently under follow-up to rule out other causes.

The diagnosis of SCB requires a multidisciplinary approach between neurologists, psychiatrists and ophthalmologists in order to avoid erroneous diagnoses. The differential diagnosis should be made with pathologies such as Lewy body dementia, Parkinson’s disease, delirium, substance intoxication, migraine aura, and metabolic encephalopathy, among others. It is important to involve the family in the treatment of the syndrome to reinforce the recognition of the unreality of these hallucinations in the patients. Antipsychotic treatment can be effective only if the condition is extremely distressing.