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Approach to the patient with visual hallucinations

Victoria S Pelak, MD
Section Editor
Paul W Brazis, MD
Deputy Editor
Janet L Wilterdink, MD


Visual hallucinations are a clinical manifestation of neuroophthalmologic dysfunction resulting from a wide variety of underlying etiologies. They can be very disconcerting to some patients, regardless of their insight, and can significantly decrease quality of life [1].

Familiarity with the disorders associated with visual hallucinations is essential to provide the appropriate care. The history, accompanying symptoms, and clinical signs are important elements for determining the most likely cause. In certain patients, further investigation may be necessary before a definitive cause can be determined.

This topic discusses the most common causes of visual hallucinations and their distinguishing features. Visual hallucinations associated with the Charles Bonnet syndrome are discussed separately. (See "Visual release hallucinations (Charles Bonnet syndrome)".)


A visual hallucination is a perception of an external visual stimulus where none exists. In contrast, a visual illusion is a distortion or modification of real external visual stimuli [2]. Examples of visual illusions include distortions of size (micropsia or macropsia), shape (metamorphopsia), and color (dyschromatopsia). Visual hallucinations and illusions are clinically distinct phenomena, but have overlapping etiologies.

A useful classification scheme categorizes hallucinations as simple or complex [3]. Classifying the hallucination as simple or complex can narrow the differential diagnosis for the underlying cause.

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Literature review current through: Nov 2017. | This topic last updated: Aug 22, 2016.
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