A World Where Images Never Leave: Exploring Palinopsia

Varsha Singh, M. Optom

Assistant Professor, KD Institute of Allied Health Sciences, Ahmedabad, India

Palinopsia is a term coined by Critchley in 1951 from the Greek word meaning again, referring to the recurring visual perception of an object after its removal. ⁽¹⁾ Palinoptic images often feature well-remembered objects or those holding emotional significance for the patient, yet any object can potentially provoke this visual recall phenomenon. ⁽¹⁾ Conversely, patients may describe visual perseveration as the image of the object trailing their eye movements like a “movie” or “strobe light” even after it exits the visual field, manifesting as rapid-moving objects producing lingering visual echoes or comet-like trails.^(2,3) Palinopsia emerges from diverse etiologies and mechanisms, including drug-induced effects, idiopathic seizures, migraines, psychiatric disorders, metabolic disturbances, head trauma, and brain structural lesions, primarily those involving parietal and parieto-occipital connections. ^(4-7)

Clinical Manifestations

Eight distinct symptom categories are involved in palinopsia, with palinoptic images characteristically lasting isochromatic (positive afterimages) relative to the original stimulus.⁽⁸⁾

S.No	Symptom	Brief Description	Retention Time
1	Formed image preservation	Clear, detailed afterimage of an object that remains stationary in the visual field after the stimulus disappears.	Usually ≥15 seconds; may persist for hours or even days.
2	Scene preservation	A previously observed short action or scene repeatedly replays in the visual field.	The scene appears within minutes and may replay for several minutes.
3	Categorical incorporation	Features of one object are merged into other objects (e.g., beard appearing on multiple people).	Episodes typically remain a few minutes.
4	Illusory visual spread / Patterned visual spread	A pattern seen on one object spreads to neighbouring objects within the visual field.	The pattern usually remains visible for several seconds to minutes.
5	Prolonged indistinct afterimage	Blurred or indistinct afterimage remains after viewing a bright stimulus.	May last few minutes or longer.
6	Light streaking	Bright lights produce streaks expanding behind the light source.	Usually persists for several seconds before fading.
7	Visual trailing	Moving objects leave trailing copies behind them, resembling motion blur.	Often lasts a few seconds.
8	Variant image preservation	Similar afterimages arise but diminish gradually with slight variations.	Typically, a couple of seconds.

table 1: This table shows the eight types of symptoms that persist in palinopsia

Types of Palinopsia

It is divided into two groups based on symptom manifestation.

1. Hallucinatory: Hallucinatory palinopsia emerges from hyperactivity or hyperexcitability in visual memory brain areas, typically due to posterior cortical lesions or seizures causing relapse of previously viewed images (from minutes or years ago) as high-resolution, long-lasting, isochromatic afterimages unaffected by environmental changes or motion, with manifestations varying across individuals. ^(8-9) It comprises formed image perseveration, scene perseveration, categorical incorporation, and patterned visual spread, featuring high-resolution perseverated images or scenes that manifest in any place in the visual field isolated from the original stimulus location and stay unaffected by environmental factors like contrast, light, or motion. ⁽⁸⁾
2. Illusory palinopsia: It represents visual perception dysfunction from abnormal brain visual pathways, frequently due to migraines, prescription/illicit drugs, or head trauma, causing unformed, low-resolution afterimages influenced by ambient light and motion, such as “comet tail” effects on currently moving objects in the visual field. ^(8-9) It includes prolonged indistinct afterimages, light streaking, visual trailing, and brief formed image perseveration. ⁽⁸⁾

Clinical Evaluation

Recognise that palinopsia represents a spectrum of symptoms rather than a discrete diagnosis; its diverse aetiologies demand comprehensive history-taking, physical examination, and diagnostic workup.⁽⁸⁾

Component	Key Clinical Points
Clinical history	Distinguish illusory vs hallucinatory palinopsia. Analyse image characteristics (content, colour, duration, delay), frequency of episodes, visual field location, and triggers like light or motion. Review headache history (migraine), seizures, stroke, tumours, trauma, neurological symptoms, and medication/drug use.
Physical examination	Conduct complete ophthalmic and neurological examination. Results are typically normal unless structural pathology exists.
Diagnostic work-up	Visual field testing and neuroimaging are often suggested. Additional tests may involve CBC, metabolic panel, EEG, electroretinogram, visual evoked potentials, lumbar puncture, or toxicology screening, advised by clinical suspicion.
Clinical considerations	Neurological deficits, unilateral visual symptoms, or visual field defects indicate cortical pathology and warrant neuroimaging and further evaluation.

table 2: The table shows the clinical workup for palinopsia

Treatment

Palinopsia may indicate stroke, a medical urgency requiring instant intervention as treatment lag risks permanent brain damage or death.⁽⁹⁾ Even transient episodes call for urgent evaluation, since they can stem from Transient Ischemic Attack (TIA), a “mini-stroke” heralding elevated stroke risk in the ensuing days despite symptom resolution. ⁽⁹⁾ For non–life-threatening causes such as seizures or migraines, neurologists or healthcare providers can advise on appropriate care thresholds; however, when in doubt, prompt medical attention should be sought to prevent potentially fatal outcomes or disability. ⁽⁹⁾

Conclusion

Palinopsia is a symptom complex instead of a diagnosis, broadly classified into hallucinatory and illusory forms. Hallucinatory palinopsia is frequently linked with cortical lesions, while illusory palinopsia is commonly linked to migraines, drugs, or head trauma.^(2,3,8,9) Accurate clinical evaluation is crucial to identify root causes, guide appropriate investigations, and ensure timely management. ^(8,9)

References

1. Critchley, M. (1951). Types of visual perseveration: “Paliopsia” and “illusory visual spread”. Brain: A Journal of Neurology.
2. Liu, G. T., Volpe, N. J., & Galetta, S. L. (2019). Visual hallucinations and illusions. In Liu, Volpe, and Galetta’s Neuro-Ophthalmology (pp. 395–413). Elsevier.
3. Trobe, J. D. (2001). Positive symptoms of retinocortical disorders.
4. Danchaivijitr, C., & Kennard, C. (2008). Cortical visual disorders—functional localization and pathophysiology. In Blue Books of Neurology (Vol. 32, pp. 332–356). Butterworth-Heinemann.
5. Abert, B., & Ilsen, P. F. (2010). Palinopsia. Optometry, 81, 394–404.
6. Bender, M. B., Feldman, M., & Sobin, A. J. (1968). Palinopsia. Brain: A Journal of Neurology, 91(2), 321–338. doi:10.1093/brain/91.2.321
7. Ghosh, R., Lahiri, D., Dubey, S., Ray, B. K., & Benito-León, J. (2020). Hallucinatory palinopsia in COVID-19-induced posterior reversible encephalopathy syndrome. Journal of Neuro-Ophthalmology: The Official Journal of the North American Neuro-Ophthalmology Society, 40(4), 523–526.
8. Gersztenkorn, D., & Lee, A. G. (2015). Palinopsia revamped: a systematic review of the literature. Survey of Ophthalmology, 60(1), 1–35.
9. Cleveland Clinic. (2025, October 6). Palinopsia: Seeing it again & again. https://my.clevelandclinic.org/health/symptoms/palinopsia

---

About the Author

Varsha Singh

Assistant Professor,

 

KD Institute of Allied Health Sciences, Ahmedabad, India