Charles Bonnet syndrome presents as visual hallucination affecting the elderly population visual perception.  The visual hallucination may present as abstract images or distinct clear small stature images know as Lilliputian, causing distress and affecting the elderly patient’s quality of life.  This syndrome has been mistaken and misdiagnosed as early onset dementia or psychosis, which furthers isolates the patient from the community.  Fear of prejudice or being labeled mentally incompetence becomes a barrier in seeking treatment.  There is not specific etiology to explain Charles Bonnet syndrome and this makes treatment a challenge for the clinician.  The difference between visual hallucination and illusion is the presence of insight and recognizing the visual image as not real.