People with prosopometamorphosia have a rare eye distortion that changes how they see faces. Its exact cause is unknown, but it is generally linked to neurological disorders like migraines, epilepsy, and abnormal findings on CT scans and MRIs of the head. It has also been associated with Epstein-Barr virus.

The British neurologist Macdonald Critchley coined the word prosopometamorphopsia to describe a type of metamorphopsia in which people see people’s faces or parts of faces distortedly. On CT studies and MRIs of the head, metamorphoses are often linked to diseases of the eyes or brain.

The disorder should not be confused with another facial recognition issue, prosopagnosia, also known as face blindness. In this more common disorder, people are affected in different ways. Some people might not tell the difference between strangers and people they do not know very well. Some people might not recognize their own faces or the faces of their family and friends. The actor, Brad Pitt, has admitted he has the disorder and frequently cannot recognize people he knows.

Different people have different symptoms that can change the size, shape, color, and placement of facial features. The problem can last days, weeks, or even years, another thing that can change about PMO.

A new study of one person gave us new information about this case of the problem. Faces do not look twisted to the 58-year-old man with PMO when they are seen on a screen or on paper, but they look “demonic” when he sees them in person. Why would it only happen when he’s with the person? It almost sounds like there’s an element of emotion involved. But his wasn’t the only case described in the professional literature because one woman with the disorder had an unusual variant of it.

In yet another description of a patient with the disorder, a right-handed 67-year-old woman with a history of coronary artery disease, high cholesterol, high blood pressure, and diabetes mellitus described how she could see people’s faces tilted to the left. It seemed like the left eye on people’s faces was moving to the side and up when she saw them in person or watched TV pictures of people.

Looking at her own face in the mirror or at pictures of faces did not cause her to see any distortion. It was no problem for her to recognize faces, and only faces seemed twisted to her. Her neurological test came back normal. Additionally, her eye test did not reveal any significant findings. After two months of showing symptoms, a brain MRI revealed a brain obstruction or subacute infarct.

People with Alice in Wonderland syndrome (AIWS) can have one of forty types of metamorphopsia. Any part of the face-processing network can be involved, from the occipital to the frontal lobe. The link between the brain’s two hemispheres plays a key role, which suggests it may be because of interhemispheric transfer. There are many reasons for this, such as a stroke, seizure, or migraine. It can change how the whole face is seen. But, curiously, up to 30% of teens have short episodes of AIWS symptoms, according to research. However, the disorder is elusive because of the lack of documentation.

What Are the Diagnostic Criteria for AIWS?

There is also disagreement among experts about the exact symptoms and criteria for the disorder. Currently, there are no agreed-upon criteria for AIWS, so physicians usually use their professional opinion to decide whether someone has it. Because of the lack of consensus, experts think that this condition is often not identified or is diagnosed wrong.

Exploring possible causation besides brain dysfunction, strange perceptual changes can happen in several other ways. It is possible for AIWS to be a sign of a mental illness or a side effect of many medications. We’ve seen this in elderly patients with dementia who are taking certain medications for allergies. Then there are medications like those found in cough medicines, montelukast, which is used to treat asthma, and topiramate, which is used to treat seizures. Brain tumors can also cause it.

Could the disorder be caused by a mental illness such as schizophrenia? Delusions and hallucinations are important signs of schizophrenia. However, visual hallucinations and illusions are less likely to be the first signs and are usually associated with substance abuse. Although psychiatrists are taught to ask about hallucinations, most of the time, visual illusions and hallucinations are signs of health problems because auditory hallucinations are more common. But the symptoms vary so much that this adds to the difficulty of diagnosis.

Currently, the professional literature lists 42 visible symptoms and 16 somesthetic and other nonvisual symptoms. These signs differ from hallucinations or illusions. Treatments vary according to how the symptoms are viewed and have been treated with various methods, including ECT.

Researchers now know that, while AIWS is rare, it may be under-reported because of the lack of diagnostic criteria. However, it appears to be a short-lived perceptual change in many cases.

Anyone experiencing any of these symptoms is advised to consult with a medical professional for evaluation rather than think it will simply go away by itself. Significant, treatable disorders could require medical attention.

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