Navigating reality: A case report on Charles Bonnet syndrome in the setting of alcohol dependence

Charles Bonnet syndrome (CBS) is characterized by complex, well-formed visual hallucinations in individuals with visual impairment and preserved insight, often leading to diagnostic uncertainty when comorbid conditions exist. We report the case of a 48-year-old man with chronic alcohol dependence who developed vivid, recurrent hallucinations initially attributed to alcohol-related psychosis. Careful evaluation revealed preserved orientation and insight, the absence of withdrawal symptoms, and critical ophthalmologic findings of cilioretinal artery occlusion with retinal ischemia, establishing the diagnosis of CBS. This case highlights the diagnostic challenge of differentiating CBS from substance-related hallucinosis and underscores the importance of targeted ophthalmologic assessment. It also illustrates the rarity of vascular causes of CBS and the need for clinicians to consider ocular pathology in patients presenting with complex visual hallucinations, even in the presence of confounding factors such as alcohol use.