A visual hallucination is when a person sees something that is not actually there. It is a perception with no external visual stimulus — for example, seeing people, animals, lights, shapes, or scenes that no one else sees and that do not exist in the environment. These false visions can feel real to the person experiencing them, and sometimes the person knows they are not real, while other times they do not. Visual hallucinations can arise from problems in the eye, the brain, the body’s metabolism, mental health, or from substances like drugs or withdrawal. Understanding what kind of visual hallucination it is, why it is happening, and how it affects the person is the first step to proper treatment. Definitions and classification of visual hallucinations come from neurology and psychiatry textbooks and review articles, which describe them as awake visual perceptions without an external source. ScienceDirect ScienceDirect The Hospitalist Blog
Visual hallucinations are seeing things that are not really there. These can be simple — like flashes of light, shapes, or colors — or complex — like people, animals, landscapes, or scenes. They occur while the eyes are working or even in people with vision loss, and the person may or may not realize the image is not real. Visual hallucinations are not a single disease; they are a symptom caused by many different conditions including neurological disorders (like Parkinson’s disease, dementia with Lewy bodies, epilepsy, brain tumors), psychiatric illness (such as schizophrenia), sensory loss (as in Charles Bonnet syndrome), metabolic problems, medication side effects, or infections and inflammation of the brain. The brain’s visual processing system misfires, either because of abnormal input (such as loss of vision leading to “phantom” images) or abnormal internal signaling (as in neurodegenerative disorders), causing vivid false visual perceptions. These experiences can be frightening, confusing, or sometimes benign, depending on cause and insight. PMC PubMed lenus.ie Frontiers MedLink
Visual hallucinations happen when the normal balance between sensory input and internal brain activity is disturbed. In people with poor vision, the brain does not receive enough visual signals and compensates by “filling in” images (deafferentation), leading to Charles Bonnet syndrome. In neurodegenerative diseases like Parkinson’s disease or dementia with Lewy bodies, the chemicals and circuits that regulate perception (especially involving dopamine and acetylcholine systems) become abnormal, making the brain misinterpret internal noise as real images. In epilepsy, especially involving the occipital lobe, abnormal electrical discharges directly produce visual scenes. Psychiatric disorders like schizophrenia involve altered dopamine signaling and disruptions in reality filtering so hallucinations (including visual) become more frequent. Inflammation, autoimmune attacks, tumors, or medication effects can similarly distort neuronal communication. FrontiersResearchGate
Types of Visual Hallucinations
Visual hallucinations are usually divided into two broad categories: simple (elementary) and complex (formed), and there are some additional phenomenological subtypes that help clinicians understand their origin.
1. Simple (Elementary) Visual Hallucinations: These are basic visual phenomena such as flashes of light, colors, geometric patterns, shapes, or movement with no detailed form. They often look like spots, lines, swirling colors, or vague shapes. Simple hallucinations frequently arise from irritation or abnormal activity in the visual pathways, particularly the occipital lobe of the brain, or sometimes from eye-related disturbances. They tend to be brief and may move across the field of vision. Wikipedia
2. Complex (Formed) Visual Hallucinations: These are clear, detailed images such as people, animals, scenes, objects, or entire situations. They can be vivid and lifelike. A person might see a person sitting in the room, animals walking, or a full scene playing out as if real. Complex hallucinations more often involve higher-order visual processing areas and can be seen in disorders like dementia with Lewy bodies or Charles Bonnet syndrome. WikipediaNCBIJNNP
3. Charles Bonnet–type Hallucinations: Though they fall under complex hallucinations, Charles Bonnet syndrome deserves separate mention because it happens in people with significant vision loss but no psychiatric illness. These patients see complex images — often repeated and detailed — while their mind and reasoning remain intact. They usually recognize the images are not real after some time, and the hallucinations are thought to result from the brain “filling in” missing visual input. NCBI
4. Peduncular Hallucinosis: This is a specific subtype where vivid, often well-formed visual hallucinations occur due to lesions near the midbrain or brainstem (particularly around cerebral peduncles). People are usually fully awake, aware, and sometimes interact with the hallucinated images. These hallucinations often occur in the evening and can be persistent during the episode. Wikipedia
5. Hypnagogic and Hypnopompic Hallucinations: These occur at the edge of sleep—just before falling asleep (hypnagogic) or upon waking (hypnopompic). They are usually brief, and insight is preserved (the person often recognizes them as not real). They are common in narcolepsy but can also be experienced in normal individuals during sleep transitions. Wikipedia
6. Illusions vs Hallucinations: While not a separate type of hallucination, it is important to distinguish illusions—distortions or misinterpretations of real external stimuli—from true hallucinations where no external stimulus exists. For example, seeing a coat on a chair and interpreting it as a person (illusion) is different from seeing a person where nothing is present (hallucination). The Hospitalist Blog
Causes of Visual Hallucinations
Visual hallucinations can come from many different underlying problems. Below are twenty distinct causes, each explained in simple terms.
Dementia with Lewy Bodies (DLB): In this type of dementia, the brain has abnormal protein deposits called Lewy bodies. People often have clear visual hallucinations, such as seeing people or animals that are not there, and they tend to fluctuate in clarity. The hallucinations are usually well formed, and the person may or may not initially recognize them as false. PMCJNNP
Parkinson’s Disease (especially with cognitive changes): Parkinson’s can cause visual hallucinations, often due to a combination of the disease’s effect on brain circuits and medications that alter dopamine levels. These hallucinations are frequently complex and can include seeing people, animals, or small figures. Insight may remain early on. WikipediaJNNP
Charles Bonnet Syndrome: People with severe visual loss (e.g., from macular degeneration or cataracts) may begin to see detailed images. The brain is deprived of normal input and makes up scenes. The person is usually aware that the visions are not real once they understand the syndrome, but the images can repeat and be distressing initially. NCBI
Delirium (acute confusional state): When someone’s brain is suddenly unwell—because of infection, dehydration, medication effects, or organ failure—they can see things that aren’t there. These hallucinations are often part of a confused mental state, with fluctuating alertness and attention. They may also hear or feel false things along with visual hallucinations. MedscapePMCBrightFocus Foundation
Temporal Lobe Epilepsy / Occipital Seizures: Seizures that arise in visual or temporal brain areas can produce short-lived visual hallucinations. Occipital seizures often cause simple visual phenomena like flashing lights or geometric shapes, while temporal lobe seizures can produce complex images like people or animals. These usually last seconds to minutes and may be localized to one side of the vision. Wikipedia
Migraine (with visual aura or in recovery states): Some people with migraine experience visual hallucinations during the aura phase, such as shimmering lights or zigzag patterns. In rare severe cases like “migraine coma” or complex migraines, more elaborate visual misperceptions can occur during recovery. Wikipedia
Medication-Induced Hallucinations: Many drugs can cause visual hallucinations, especially those with anticholinergic effects (like some antihistamines), dopaminergic medications, opioids, steroids, and certain sleep or psychiatric drugs. Hallucinogenic substances (LSD, psilocybin), dissociatives (like high-dose ketamine or dextromethorphan), and withdrawal from substances such as alcohol can also cause vivid visual phenomena. Psychiatrist.comWikipedia
Psychotic Disorders (e.g., Schizophrenia): Some psychiatric illnesses can produce visual hallucinations, although auditory hallucinations are more classic. When visual hallucinations are present, they can be part of a broader break with reality, and the person may lack insight into their false nature. Differentiating primary psychiatric causes from neurological ones requires careful evaluation. Psychiatrist.com
Brain Tumors: Tumors in or near the visual pathways (occipital lobe, temporal lobe, or optic radiations) can irritate the brain tissue and cause visual hallucinations. The content may be simple or complex depending on location, and there may be other signs like weakness, headache, or seizures. JNNP
Stroke and Transient Ischemic Attacks (TIAs): When blood flow is reduced or blocked in parts of the brain that process vision, hallucinations can occur. Visual hallucinations from strokes may be sudden and accompanied by other neurological signs like weakness or speech difficulty. JNNP
Infections of the Brain (e.g., Encephalitis, Meningitis): Infections that inflame brain tissue can disrupt perception and cause hallucinations. This is often part of a broader picture with fever, headache, confusion, or stiffness in the neck. PMCBrightFocus Foundation
Metabolic Disturbances (e.g., low blood sugar, kidney failure, liver failure): When the body’s chemicals are out of balance, the brain can be confused and generate visual hallucinations. Low blood sugar can cause rapid-onset hallucinations, while buildup of toxins in kidney or liver disease (uremia or hepatic encephalopathy) can lead to more persistent perceptual disturbances. PMCBrightFocus Foundation
Sensory Deprivation: When the brain does not receive normal visual input—for example, from prolonged darkness, blindness, or even isolation—the visual cortex may begin to produce its own images, sometimes causing hallucinations similar to Charles Bonnet syndrome. Wikipedia
Sleep Deprivation and Sleep Disorders: Lack of sleep can disrupt normal brain function and lead to hallucinations, including visual ones. Disorders like narcolepsy can cause hypnagogic or hypnopompic hallucinations that are vivid but occur around sleep transitions. Wikipedia
Parkinsonian Syndromes and Dementia Overlaps (e.g., Parkinson’s disease dementia): Beyond classic Parkinson’s disease, when cognitive decline is present or overlaps with other dementias, visual hallucinations are common—and may reflect both disease pathology and medication effects. JNNP
Autoimmune Encephalitis (e.g., NMDA receptor, limbic encephalitis): Autoimmune attacks on the brain can cause a range of neuropsychiatric symptoms, including visual hallucinations, often along with memory problems, seizures, or behavioral changes. Early diagnosis is critical for treatment. PMC
Toxic Exposures (e.g., heavy metals, carbon monoxide): Exposure to toxic substances can impair brain function and lead to hallucinations. For instance, severe carbon monoxide poisoning can damage brain tissue and produce visual misperceptions as part of a broader encephalopathy. BrightFocus Foundation
Vision Pathway Lesions (optic nerve, chiasm, radiations): Damage anywhere along the visual pathway—from the eye to the back of the brain—can cause the brain to misinterpret signals, sometimes resulting in hallucinations or visual distortions. This includes demyelinating diseases like multiple sclerosis or compressive lesions. JNNP
Charles Bonnet–like Hallucinations in Non-Visual Diseases (e.g., release phenomena): When sensory input is lost or significantly reduced, the brain may generate its own content (a “release” phenomenon), not only in vision but analogous to phantom limb sensations. In vision, this can mimic simple or complex hallucinations even if the eye structure is intact but input is reduced. Wikipedia
Psychological Stress and Trauma: Severe stress, grief, or traumatic experiences can sometimes lead to brief visual hallucinations. These are usually transient, and insight may be maintained; however, when persistent or distressing, they require evaluation to rule out other causes. Psychiatrist.com
Symptoms Associated with Visual Hallucinations
Visual hallucinations often come with additional signs or specific qualities. Below are fifteen common symptoms or features people experience, with explanations.
Seeing People or Figures: The person may report seeing other people, family members, strangers, or figures that are not present. These can appear fully formed and lifelike. This is common in complex hallucinations such as in Lewy body dementia. PMCJNNP
Seeing Animals: Hallucinated animals—realistic or strange—are often seen, especially in Charles Bonnet syndrome or neurologic causes. The animals may behave normally or in unusual ways. NCBI
Flashes of Light or Colors (Simple Phenomena): The person might see brief bright lights, shapes, or colors with no pattern or form. These are typical of simple visual hallucinations, often from occipital lobe activity or visual pathway irritation. Wikipedia
Scenes or Landscapes: Whole environments, rooms, or outdoor landscapes can be hallucinatory, sometimes layered over the real visual field. These are usually complex and may feel immersive. Wikipedia
Distorted Size or Shape (Metamorphopsia): Objects or people may appear larger, smaller, stretched, or misshapen. Though sometimes classified as illusions, severe distortions can border on hallucinatory perception. The Hospitalist Blog
Persistent vs Brief Duration: Some hallucinations last only seconds (as in seizures), while others persist for minutes or longer (as with dementia or Charles Bonnet). The length of time gives clues about cause. Wikipedia
Insight Preserved or Lost: In some cases (e.g., Charles Bonnet or peduncular hallucinosis), people understand that what they see is not real; in others (like psychosis), that insight may be absent. Whether the person knows the vision is false helps narrow cause. The Hospitalist Blog
Associated Confusion or Cognitive Fluctuation: Especially in delirium or Lewy body dementia, visual hallucinations come with changes in thinking, attention, or alertness that go up and down. PMCPMC
Fear or Anxiety: Hallucinations can provoke strong emotions. Seeing threatening images, distorted faces, or unfamiliar figures often causes fear, which may amplify the experience and the person’s distress. Psychiatrist.com
Recurrent Images: Certain hallucinations repeat — the same person, pattern, or scene may appear multiple times over days or weeks, adding to the confusion about reality, as seen in Charles Bonnet syndrome. NCBI
Visual Field Locality: Sometimes hallucinations are limited to one part of the visual field (e.g., one side), which suggests a focal brain cause such as a seizure or stroke in the visual cortex. Wikipedia
Combination with Other Sensory Hallucinations: Although visual hallucinations can occur alone, in some disorders (like delirium or drug-induced states) they may occur with hearing, smell, or tactile hallucinations, making the experience multi-sensory and more confusing. PMCPsychiatrist.com
Illusory Movement (Lilliputian): Objects might appear smaller or moving in strange ways. Small people or creatures, sometimes called “Lilliputian” hallucinations, are seen in conditions affecting visual association areas. Wikipedia
Visual Disturbances Before Full Hallucination: Some people have early visual distortions, such as blurring, shimmering, or shadows, before a full hallucination appears. This can happen in migraine aura or seizure-related visual phenomena. Wikipedia
Interference with Daily Life: Persistent or distressing visual hallucinations can impair functioning, cause avoidance behavior, or lead to safety concerns, especially if the person reacts to non-existent threats. Recognizing the real-world impact is important for urgency. PMCPsychiatrist.com
Diagnostic Tests
To find the cause of visual hallucinations, doctors use a combination of exams and tests. Below are 20 diagnostic approaches, divided into the requested categories, each explained in simple terms.
A. Physical Examination (including basic neurological and general evaluation)
General Vital Signs and Mental Status Examination: The clinician checks temperature, blood pressure, heart rate, breathing, and does a quick assessment of alertness, orientation (time/place/person), memory, and attention. This helps find delirium, infection, or systemic causes. PMC
Neurological Examination (including cranial nerves): This includes checking eye movements, pupil reactions, visual fields by confrontation, reflexes, strength, coordination, and sensation. It helps identify strokes, tumors, or focal brain lesions. JNNP
Fundoscopic Eye Exam: The doctor looks inside the eye to check for retinal disease, optic nerve swelling, or signs of pressure in the brain. Problems here can indirectly contribute to visual disturbances or help rule out a primary eye cause. JNNP
Assessment of Insight and Reality Testing: Through conversation, the clinician evaluates if the person knows the hallucination isn’t real. This helps differentiate psychiatric from some neurological causes. The Hospitalist Blog
B. Manual/Bedside Tests
Confrontation Visual Field Testing: The clinician tests peripheral vision by having the patient look ahead while the examiner brings objects into different parts of the field. This can reveal field cuts from strokes or lesions. JNNP
Amsler Grid Test: Often used when macular pathology is suspected (e.g., in Charles Bonnet syndrome with underlying eye disease), the patient looks at a grid to detect distortions or missing areas. NCBI
Pupil Light Reflex and Accommodation Testing: This checks whether the pupils respond normally to light and focus. Abnormalities may hint at optic nerve or midbrain issues that could relate to visual perception. JNNP
Simple Cognitive Screening (e.g., MMSE or MoCA): These brief tests help detect underlying dementia or delirium that could be causing or contributing to hallucinations. Cognitive decline often coexists with visual hallucinations in disorders like DLB. PMCPMC
C. Laboratory and Pathological Tests
Complete Blood Count (CBC) and Basic Metabolic Panel: Low oxygen, anemia, infection, or imbalances (like low sodium or high calcium) can cause brain dysfunction leading to hallucinations. These tests screen for common reversible causes. PMCBrightFocus Foundation
Liver and Kidney Function Tests (LFTs, BUN/Creatinine): Poor liver or kidney function allows toxins to build up that affect the brain, leading to hallucinations, confusion, or delirium. PMCBrightFocus Foundation
Blood Glucose Measurement: Extremely low or high blood sugar can disrupt brain function rapidly, leading to visual hallucinations and other symptoms. BrightFocus Foundation
Thyroid Function Tests: Hypothyroidism or hyperthyroidism can cause cognitive changes and occasionally hallucinations as part of broader encephalopathy. BrightFocus Foundation
Vitamin B12 and Folate Levels: Deficiencies in these vitamins can cause neurological changes, including hallucinations, memory issues, and confusion. BrightFocus Foundation
Infection Markers / Serologies (e.g., HIV, Syphilis, CRP/ESR): Infections and inflammation affecting the brain may be chronic or acute. Testing for common treatable infections that can mimic or cause cognitive and perceptual changes is essential. PMCBrightFocus Foundation
Toxicology Screen and Medication Review: Checking for drugs in the blood (recreational or prescription) and reviewing medications can reveal substance-induced hallucinations or withdrawal states. Psychiatrist.com
D. Electrodiagnostic Tests
Electroencephalogram (EEG): This measures electrical activity of the brain and can detect seizure activity (especially occipital or temporal lobe seizures) that might cause visual hallucinations, as well as diffuse slowing seen in delirium. Wikipedia
Visual Evoked Potentials (VEP): This test measures the brain’s electrical response to visual stimuli and can help determine if the vision pathways from the eye to the visual cortex are functioning properly, useful when pathway dysfunction is suspected. JNNP
Electroretinogram (ERG): Though more specialized, ERG tests retinal function and helps rule out primary retinal disease that might be altering visual input and causing secondary cortical hallucinations. JNNP
E. Imaging Tests
Magnetic Resonance Imaging (MRI) of the Brain (with and without contrast): MRI is the best test to look for structural problems like tumors, strokes, inflammation, or degenerative changes in the brain regions that process vision and perception. It helps detect causes like Lewy body changes, autoimmune encephalitis (indirectly), or space-occupying lesions. JNNP
Computed Tomography (CT) Head: Faster than MRI; useful in emergencies to detect bleeding, large strokes, or masses when a quick answer is needed. It can be followed by MRI for more detail. JNNP
(Additional advanced imaging if needed, though beyond the core twenty, includes PET/SPECT for metabolic brain changes in dementia and functional MRI for research contexts. These are used selectively when the cause remains unclear after initial workup.) JNNP
Non-Pharmacological Treatments
Each of these is a non-drug approach that helps reduce the frequency, distress, or impact of visual hallucinations by addressing causes, improving coping, or normalizing perception.
Reassurance and Education: Simply telling patients that their visual hallucinations have a medical explanation (e.g., Charles Bonnet syndrome in vision loss) reduces fear and distress. Knowing they are not “going crazy” often improves coping and decreases reporting delay. PMC
Vision Correction and Sensory Input Improvement: Fixing reversible vision problems (e.g., cataracts, refractive errors) enhances real visual input, reducing the brain’s tendency to generate hallucinations from lack of information. Early treatment of vision loss is preventive and therapeutic. Oxford AcademicPMC
Reality Orientation / Cognitive Stimulation Therapy: Techniques that gently orient a person to time, place, and reality (often used in dementia) help reduce confusion and the intensity of hallucinations by strengthening contextual processing. Structured cognitive stimulation has shown benefit for behavioral and psychological symptoms including hallucination-like phenomena. PMCPhysiopedia
Validation Therapy with Psychoeducation: Especially in dementia-related hallucinations, acknowledging feelings and combining with gentle education (validation) reduces resistance and emotional distress, making hallucination content less disruptive. ResearchGate
Reminiscence Therapy: Engaging the patient in meaningful memory work can shift attention away from hallucinations and improve overall cognitive/emotional state, indirectly lowering hallucination prominence in vulnerable populations. hsrd.research.va.gov
Music Therapy / Art and Recreational Therapies: Nonverbal stimulation such as music or creative activities provides alternative sensory engagement, reducing linkage to hallucinations and calming associated anxiety or agitation. ResearchGateDepartment of Mental Health
Multisensory Stimulation / Sensory Modulation (e.g., Snoezelen therapy): Gentle, controlled stimulation of sight, sound, and touch can normalize sensory processing in dementia or brain dysfunction and has been shown to reduce hallucination-related distress. hsrd.research.va.gov
Environmental Lighting and Contrast Adjustment: Some hallucinations (e.g., in Lewy body dementia) are worse in poor lighting. Improving ambient lighting and minimizing flicker helps the brain interpret real visual input correctly, reducing false perceptions. BioMed Central
Blinking, Gaze Redirection, and Simple Behavioral Coping Moves: Patients can be taught to blink rapidly, change gaze direction, or shift attention when a hallucination starts; these small maneuvers may interrupt the brain process producing the image. ResearchGate
Stress Reduction and Mindfulness Practices: High stress and anxiety can amplify hallucinations. Mindfulness, relaxation breathing, and guided imagery (mental rehearsal or calm visualization) can lower arousal, making hallucinations less frequent or intrusive. Wikipedia
Sleep Hygiene: Poor or fragmented sleep worsens reality testing and can trigger hallucinations. Regular sleep schedule, limiting stimulants before bed, and optimizing sleep environment reduce incidence. PMC
Social Engagement and Support Groups: Isolation can exacerbate perceptual disturbances. Regular interaction, peer support, and group therapy give grounding feedback and share coping tips. highlandsbhs.com
Behavioral Activation / Structured Daily Routine: Keeping the brain engaged with predictable tasks reduces idle time during which hallucinations may intrude. Routine gives anchoring cues to the real world. hsrd.research.va.gov
Medication Review and Deprescribing: Non-drug strategy of systematically reviewing all current medications (especially anticholinergics, high-dose dopaminergics, or polypharmacy) can identify and remove contributors to hallucinations. BioMed Central
Occupational Therapy / Adaptive Strategies: Occupational therapists help modify the environment and daily tasks to reduce triggers or minimize the functional impact of hallucinations (e.g., improving lighting, reducing clutter). Department of Mental Health
Cognitive Behavioral Techniques for Hallucination Management: Specific CBT adaptations (challenging beliefs about hallucination content, shifting attention, developing coping statements) have evidence in psychosis to reduce distress from hallucinations. PMC
Sensory Substitution (e.g., tactile or auditory cues): Providing alternate sensory feedback can help the brain ground perception and diminish reliance on falsely generated visual content. Oxford Academic
Physical Exercise: Regular aerobic exercise improves overall brain health, neurochemical balance, and stress resilience; it indirectly reduces psychiatric and neurodegenerative symptom severity, including hallucination burden. PMC
Hydration and Nutritional Support: Ensuring adequate fluid and nutrient intake prevents metabolic disturbances (like dehydration, vitamin deficiencies) which can precipitate transient hallucinations, especially in elderly or medically ill. PMC
Caregiver Training and Structured Communication: Teaching caregivers how to respond calmly, redirect attention, and provide consistent feedback reduces escalation and helps patients feel safe, which lowers hallucination-related distress. PMCPMC
Drug Treatments
Drug choice depends on the underlying cause. Below are commonly used evidence-based medications for visual hallucinations, with class, typical purpose, mechanism, dosing outline (general), and common side effects. Precise dose must be adjusted by clinician per individual and comorbidities.
Quetiapine (Atypical Antipsychotic): Used especially in Parkinson’s disease dementia (PDD) and dementia with Lewy bodies (DLB) when hallucinations cause distress. It modulates serotonin and dopamine receptors, reducing misperceived visual signals. Typical low starting dose is 6.25–25 mg at night, titrated slowly; maintenance often 12.5–50 mg/day. Purpose is to reduce psychosis without strong motor worsening. Side effects: sedation, orthostatic hypotension, metabolic changes, rare risk of extrapyramidal symptoms at higher doses. Lewy Body Dementia Association
Pimavanserin (Selective Serotonin Inverse Agonist): FDA-approved for Parkinson’s disease psychosis (including visual hallucinations). It targets 5-HT2A receptors without blocking dopamine, so it avoids worsening motor symptoms. Dose: 34 mg once daily. Purpose: reduce hallucinations and delusions in PD. Side effects: peripheral edema, confusion, QT prolongation (monitor). Lewy Body Dementia Association
Clozapine (Atypical Antipsychotic): Reserved for refractory visual hallucinations in Parkinson’s-related psychosis or schizophrenia when others fail. Mechanism includes blocking multiple neurotransmitter receptors (dopamine, serotonin). Very low start (12.5 mg once or twice daily) with slow titration. Purpose: potent psychosis control. Side effects: severe (agranulocytosis requiring blood monitoring), sedation, seizures, metabolic syndrome. PMCPMC
Rivastigmine (Cholinesterase Inhibitor): Used in Lewy body dementia and Parkinson’s dementia. It increases acetylcholine in the brain, which helps stabilize perception and reduces visual hallucinations. Typical dosing begins at 1.5 mg twice daily (patch forms are available), titrated up. Purpose: symptomatic reduction of hallucinations and cognitive symptoms. Side effects: nausea, vomiting, weight loss, bradycardia. BioMed CentralScienceDirect
Donepezil (Cholinesterase Inhibitor): Though evidence is stronger for rivastigmine in hallucinations, donepezil is sometimes used for cognitive impairment in dementia-related hallucinations. It works similarly to enhance cholinergic signaling. Typical dose 5–10 mg nightly. Side effects: gastrointestinal upset, vivid dreams, bradycardia. ScienceDirect
Risperidone (Atypical Antipsychotic): Used in psychotic disorders (e.g., schizophrenia) to reduce hallucinations by modulating dopamine and serotonin. Dosing for hallucinations usually starts very low (0.25–0.5 mg/day) especially in elderly; titrate cautiously. Purpose: reduce severity/frequency of hallucinations. Side effects: extrapyramidal symptoms, metabolic changes, sedation, increased risk in dementia (stroke/mortality warning). PMCFrontiers
Olanzapine (Atypical Antipsychotic): Comparable efficacy to other antipsychotics for hallucinations in schizophrenia. Works on multiple receptors (dopamine, serotonin). Starting dose often 2.5–5 mg at night. Side effects: significant weight gain, metabolic syndrome, sedation. PMC
Levetiracetam (Antiepileptic): Used when visual hallucinations arise from occipital epileptic activity; it stabilizes abnormal neuronal firing by modulating synaptic neurotransmitter release. Typical dosing begins at 500 mg twice daily, adjusted for renal function. Purpose: suppress seizure-related hallucinations. Side effects: mood changes, dizziness, fatigue. JNNP
Valproate (Mood Stabilizer/Antiepileptic): Sometimes used when seizures or mood instability contribute to hallucinations; it increases GABA and stabilizes brain excitability. Dosing varies (e.g., 250–500 mg 2–3 times daily), guided by blood levels. Side effects: weight gain, tremor, liver enzyme elevations, teratogenicity. vitality-medicine-and-engineering-journal.com
Memantine (NMDA Receptor Modulator): Used in some dementias to modulate glutamatergic activity; may indirectly help visual hallucinations by stabilizing cognitive networks, though evidence is less strong specifically for hallucinations. Typical dose 5 mg daily, titrated to 10 mg twice daily. Side effects: dizziness, confusion, headache. ScienceDirect
Note: Any antipsychotic use in elderly or neurodegenerative dementia carries risk of increased mortality and stroke; use the lowest effective dose, monitor closely, and prefer non-drug approaches first when possible. PMC
Dietary Molecular Supplements
These supplements have evidence (varying strength) for supporting brain health, improving underlying contributors to hallucinations, or modulating psychiatric/neurodegenerative risk. They are adjuncts, not replacements for primary treatments.
Omega-3 Fatty Acids (EPA/DHA): Typical dosage 1–2 grams per day of combined EPA/DHA. Function: anti-inflammatory and membrane stabilization in neural tissue. Mechanism: incorporation into neuronal membranes, modulating neurotransmission and reducing neuroinflammation; some trials show reduction in positive symptoms including hallucinations in schizophrenia. Side effects: mild gastrointestinal upset, increased bleeding risk at high doses. WebMDPeaceHealthVerywell Mind
Vitamin B12 (Cobalamin): Dosage depends on deficiency; common oral dose 1000 mcg daily or intramuscular injections per deficiency protocol. Function: supports myelin and neuronal integrity. Mechanism: involved in methylation and DNA synthesis; deficiency can cause neuropsychiatric symptoms including perceptual disturbances. PMC
Folate / Methylfolate (Vitamin B9): Typical supplemental methylfolate 7.5–15 mg daily (depending on genetic polymorphisms). Function: supports methylation cycles affecting neurotransmitter synthesis. Mechanism: contributes to serotonin and dopamine pathways; supplementation can augment psychiatric treatment response. PMCMDPI
Vitamin D: 1000–4000 IU daily depending on baseline level. Function: neuroimmune modulation and mood support. Mechanism: vitamin D receptors in brain affect neurotransmission and inflammation; low levels correlate with worse psychiatric symptoms. PMC
N-Acetylcysteine (NAC): Common dose 600–1200 mg twice daily. Function: antioxidant and glutamate modulation. Mechanism: replenishes glutathione, modulates extracellular glutamate, which can stabilize abnormal neuronal signaling implicated in hallucinations in schizophrenia and other disorders. PMCMDPI
Zinc: 25–50 mg daily (with caution to avoid excess). Function: cofactor in neurotransmitter metabolism and brain immune regulation. Mechanism: involved in GABA and glutamate balance; some evidence of mood benefit when combined with antidepressant therapy. PMCMDPI
Probiotics / Gut-Brain Axis Support: Strains vary; typical approach is a broad-spectrum probiotic daily. Function: supports intestinal health influencing systemic inflammation and neurotransmitter precursor production. Mechanism: modulating microbiome can affect serotonin and immune signaling to the brain. MDPI
S-Adenosylmethionine (SAMe): Dosage 200–400 mg daily. Function: supports methylation and neurotransmitter synthesis (e.g., dopamine, serotonin). Mechanism: serves as a methyl donor in biochemical reactions relevant to mood and cognition, augmenting antidepressant effects that may indirectly reduce hallucinatory distress. PMC
Magnesium: 200–400 mg elemental magnesium (often magnesium citrate or glycinate) nightly. Function: stabilizes neuronal excitability and reduces cortical hyperactivity. Mechanism: NMDA receptor modulation and calcium channel regulation; may help with migraine-related visual disturbances that can mimic or trigger hallucination-like phenomena. PMC
Ginkgo Biloba: Typical dosage 120–240 mg/day standardized extract. Function: may enhance cerebral blood flow and have mild antioxidant effects. Mechanism: uncertain; proposed to modulate neurotransmission and neuroinflammation. Evidence is mixed and quality variable; caution with bleeding risk and interaction with anticoagulants. Verywell Health
Important note: Dietary supplements vary in quality and regulation. The strongest long-term improvements in brain health come from overall diet and lifestyle; supplements should be used in consultation with a healthcare provider, especially to avoid interactions. Verywell Health
Regenerative / Experimental / Immunomodulatory Therapies
These are emerging or specialized interventions targeting the underlying disease processes that can give rise to visual hallucinations, especially in neurodegeneration, autoimmune disease, or visual deafferentation.
Induced Pluripotent Stem Cell (iPSC)-Derived Dopaminergic Neuron Transplantation (Parkinson’s Disease): Aims to replace lost dopaminergic neurons in the substantia nigra, restoring normal dopamine signaling and reducing both motor symptoms and psychosis/hallucinations by eventually allowing reduction of hallucination-provoking medications. This is in advanced clinical trial stages with phase 3 planned. PubMedUCI Health
Mesenchymal Stem Cell (MSC) Therapy for Neuroinflammatory Disorders (e.g., Multiple Sclerosis): MSCs have immunomodulatory effects that can reset harmful autoimmune activity, reduce brain inflammation, and potentially restore neural function. Autologous use has shown disease activity reduction, which could indirectly decrease hallucinations when inflammation or demyelination affects perception pathways. MDPI
Autologous Hematopoietic Stem Cell Transplantation (HSCT) for Refractory Autoimmune Neurological Disease: Used in severe autoimmune encephalitis or multiple sclerosis to “reset” the immune system, drastically reducing aberrant immune attacks on the brain. This can resolve hallucination-causing inflammation. MDPI
Neuroprotective Erythropoietin (EPO) Analogues: Beyond blood production, EPO has been studied for neuroprotection, reducing neuronal apoptosis and inflammation in various brain injuries or degeneration, potentially stabilizing perception networks and reducing hallucination susceptibility. PMC (inference: EPO’s neuroprotective properties may support neural stability; direct evidence for hallucinations is emerging)
Retinal Pigment Epithelium (RPE) Stem Cell Transplantation (for Vision Restoration): In age-related macular degeneration and other retinal degenerations leading to deafferentation visual hallucinations (e.g., Charles Bonnet syndrome), transplanting stem cell–derived RPE or retinal progenitor cells improves real visual input, reducing the stimulus for hallucinations caused by visual loss. Several clinical trials show partial vision improvement and structural integration. PubMedPMCFrontiersBioMed Central
Experimental Neurotrophic Factor Delivery (e.g., GDNF gene/protein approaches): Aims to support survival and function of neurons in degenerative diseases (e.g., Parkinson’s) so that degraded networks responsible for abnormal perceptions stabilize. While still experimental, these factors may decrease hallucinations by improving underlying network health. PMC (inference based on neuroprotection concepts)
Surgeries / Procedures
Brain Tumor Resection (e.g., Occipital Lobe Lesion): If a tumor presses on or irritates visual processing regions, it may generate visual hallucinations. Surgical removal of the lesion reduces abnormal signaling and can stop or lessen hallucinations. Imaging and biopsy guide extent of resection. ResearchGateJNNP
Epilepsy Focus Resection (Occipital Lobe Epilepsy): When visual hallucinations are due to focal seizures in visual cortex, surgery to remove or disconnect the seizure focus (after careful mapping) can eliminate the abnormal discharges causing hallucinations. JNNP
Cataract Surgery / Vision Restoration Procedures: In Charles Bonnet syndrome and other vision-loss–related hallucinations, improving the clarity of real visual input via cataract removal or corrective eye surgery decreases the brain’s need to “fill in” missing data, which often reduces hallucination frequency and distress. PMCOxford Academic
Retinal Surgery / RPE Transplantation (for Degenerative Retinal Disease): Advanced surgical delivery of stem cell–derived retinal pigment epithelial cells or retinal prosthetics aims to restore or improve retinal function, thus reducing deafferentation-induced hallucinations from vision loss. PMCBioMed Central
Deep Brain Stimulation (DBS) with Medication Titration (Parkinson’s Disease): While DBS targets motor symptoms, successful DBS can allow physicians to lower dosages of dopaminergic drugs that sometimes provoke psychosis and visual hallucinations. The procedure involves placing electrodes in specific brain nuclei to modulate circuitry. Frontiers (inference: reducing medication load via DBS can secondarily decrease hallucinations in Parkinson’s disease)
Preventions (How to Lower Risk or Prevent Visual Hallucinations)
Early and Regular Eye Exams: Detect and treat vision loss (e.g., cataract, macular degeneration) before deafferentation triggers hallucinations. Oxford Academic
Manage Neurodegenerative Conditions Actively: Regular neurologic follow-up for Parkinson’s, dementia, or Lewy body disease with early use of supportive therapies reduces progression to complex hallucinations. BioMed Central
Medication Review to Avoid Hallucinogenic Triggers: Avoid or adjust drugs known to cause perceptual disturbances (anticholinergics, high-dose dopaminergics, some steroids, recreational substances) through periodic review. BioMed Central
Maintain Good Sleep and Circadian Health: Prevent hallucination exacerbation from sleep deprivation or irregular sleep patterns through consistent sleep hygiene. PMC
Reduce Sensory Deprivation: For people with partial vision loss or hearing issues, use visual aids, ambient enrichment, and avoid isolation to keep perceptual systems engaged. Oxford Academic
Control Chronic Systemic Illness (Diabetes, Hypertension): Prevent strokes, infections, and metabolic derangements that can cause delirium or neurological damage leading to hallucinations. hsrd.research.va.gov
Manage Stress and Anxiety: Chronic stress lowers the threshold for perceptual misinterpretation; regular mindfulness, therapy, and relaxation improve resilience. Wikipedia
Nutritious Brain-Healthy Diet: Adopting Mediterranean-style eating with antioxidants, omega-3s, and vitamins supports brain stability and lowers risk of cognitive irritability. PMCPMC
Prompt Treatment of Infections or Autoimmune Flare-ups: Early intervention in autoimmune encephalitis or systemic infection prevents inflammation from spreading to brain areas involved in perception. MDPI
Social Engagement and Cognitive Activity: Keeping the mind active and socially connected maintains reality testing and reduces vulnerability to hallucination-like distortions. hsrd.research.va.gov
When to See a Doctor
You should seek medical evaluation immediately if any of these occur:
Sudden onset of visual hallucinations without previous history, especially if accompanied by confusion or altered awareness. PMC
Loss of insight (believing hallucinations are real) and they interfere with daily safety. PubMed
Neurological symptoms such as weakness, visual field cuts, seizures, or imbalance, which might suggest a structural brain lesion. JNNP
Rapid cognitive decline or accompanying memory problems, which could signal dementia or delirium. PMC
Hallucinations in the context of fever, infection, or immune issues, raising concern for encephalitis. MDPI
Persistent hallucinations despite good sleep and no drug triggers, which needs underlying cause workup. ResearchGate
Hallucinations after medication changes (especially starting or stopping psychiatric or neurological meds). BioMed Central
Hallucinations with visual loss and distress (to differentiate Charles Bonnet from more dangerous causes). PMC
Hallucinations that provoke self-harm, aggression, or severe anxiety. highlandsbhs.com
Any new visual hallucinations in elderly patients, since they may mask treatable underlying degenerative or vascular disease. JNNP
What to Eat and What to Avoid
What to Eat (support brain stability and reduce risk):
Eat a Mediterranean-style diet rich in leafy greens, berries, fatty fish (source of omega-3s), nuts, whole grains, legumes, and lean proteins. These provide antioxidants, healthy fats, B vitamins, and anti-inflammatory nutrients that support neurotransmitter balance and cognitive resilience. Including vitamin D (through diet or safe sun exposure), adequate hydration, and probiotic-rich foods (like fermented items) helps gut-brain communication. PMCPMC
What to Avoid:
Limit or avoid excessive caffeine, recreational drugs (e.g., hallucinogens, stimulants), high doses of unreviewed supplements, excessive sugar/refined carbs (which can destabilize blood sugar and mood), alcohol bingeing, and medications with strong anticholinergic burden unless necessary. Also avoid prolonged sensory deprivation (e.g., very dim environments) if you have vision loss, as this can precipitate hallucinations. PMCBioMed Central
Frequently Asked Questions (FAQs)
Are visual hallucinations always a sign of mental illness?
No. They can come from many causes including vision loss (Charles Bonnet syndrome), neurological disease, seizures, infections, or medication side effects. Insight into the unreality and absence of other psychiatric symptoms often points away from primary psychiatric illness. PubMedResearchGateWhat is Charles Bonnet syndrome, and is it dangerous?
It is visual hallucinations in people with significant vision loss but intact cognition. It is not dangerous itself, but distressing. Reassurance and improving visual input help. PubMedPMCCan improving eyesight stop hallucinations?
Yes. Fixing reversible ocular problems (like cataracts) can reduce hallucinations by restoring normal visual signals. Oxford AcademicDo hallucinations mean I’m having a stroke or brain tumor?
Sometimes. Sudden new visual hallucinations with other neurological signs (weakness, speech problems) warrant urgent imaging to rule out structural lesions like tumors or vascular events. JNNPCan lack of sleep cause visual hallucinations?
Yes. Sleep deprivation lowers the brain’s filtering ability and can produce transient hallucinations. Good sleep hygiene is preventive. PMCAre there safe non-drug ways to reduce hallucinations?
Yes. Education, improving lighting, cognitive therapies, social engagement, and sensory stimulation all have evidence for reducing frequency or distress. PMCOxford AcademicWhat medications can make hallucinations worse?
Anticholinergics, high-dose dopaminergic drugs, some steroids, and certain antidepressants or recreational substances can worsen or trigger hallucinations. Medication review is important. BioMed CentralCan supplements stop hallucinations?
Supplements like omega-3s, B vitamins, NAC, and vitamin D may support brain health and reduce vulnerability, but they are adjuncts and not primary cures. Quality varies; speak with a provider. PMCVerywell HealthIs treatment different if hallucinations are from Parkinson’s vs. Charles Bonnet syndrome?
Yes. Parkinson’s hallucinations often need careful medication balancing, cholinesterase inhibitors, or low-dose atypical antipsychotics, while Charles Bonnet syndrome relies on reassurance and vision improvement. Lewy Body Dementia AssociationPMCCan hallucinations come and go?
Yes. In many causes (e.g., delirium, medication effects, sleep-related), they fluctuate. Tracking triggers and patterns helps tailor treatment. PMCWhen should I consider seeing a neurologist?
If hallucinations are new, persistent, worsening, accompanied by other neurological signs, or if there is no clear explanation from vision or medications. JNNPCan stress or anxiety make hallucinations worse?
Yes. High emotional arousal amplifies perceptual disturbances; stress reduction techniques help. WikipediaAre hallucinations in dementia treatable?
Often yes. Non-drug measures, minimizing offending medications, and cholinesterase inhibitors can reduce them. In refractory cases, cautious use of antipsychotics may be considered with risk awareness. ScienceDirectPMCIs it safe to take multiple supplements for brain health?
Combining supplements should be done thoughtfully; some interact (e.g., high zinc vs. copper balance) and overdosing fat-soluble vitamins can be harmful. Discuss with a clinician. Verywell HealthWill stem cell or regenerative therapy help my hallucinations?
Possibly, if hallucinations are due to underlying neurodegeneration or vision loss. These therapies are mostly experimental now (Parkinson’s, retinal disease) and aim to repair or replace damaged tissue, which could reduce hallucination triggers over time. PubMedPMCBioMed CentralMDPI
Disclaimer: Each person’s journey is unique, treatment plan, life style, food habit, hormonal condition, immune system, chronic disease condition, geological location, weather and previous medical history is also unique. So always seek the best advice from a qualified medical professional or health care provider before trying any treatments to ensure to find out the best plan for you. This guide is for general information and educational purposes only. Regular check-ups and awareness can help to manage and prevent complications associated with these diseases conditions. If you or someone are suffering from this disease condition bookmark this website or share with someone who might find it useful! Boost your knowledge and stay ahead in your health journey. We always try to ensure that the content is regularly updated to reflect the latest medical research and treatment options. Thank you for giving your valuable time to read the article.
The article is written by Team RxHarun and reviewed by the Rx Editorial Board Members
Last Updated: August 02, 2025.
