Charles Bonnet syndrome (CBS) is characterised by visual hallucinations in the presence of normal mental functioning in those with visual impairment. CBS is often undiagnosed due to lack of voluntary patient disclosure and limited clinician awareness. Eye care practitioners are ideally placed to screen for hallucinations. This paper outlines the demographics, clinical features, current theories of pathogenesis and management of this intriguing phenomenon. Simple strategies such as explanation, reassurance, advice and maximising vision are often all that is required. Individuals needing further help should be referred appropriately, as should those in whom another diagnosis is suspected.