Multiple sclerosis and your eyes — Nystagmus; Twitching; Optic neuritis, and More

Stuart SchlossmanMultiple Sclerosis, Multiple Sclerosis (MS) Symptoms

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MS is characterized by the immune system damaging myelin — a
substance that surrounds and protects nerve fibers. Damaged areas of myelin are
referred to as plaques or lesions.
Demyelinating lesions can affect different parts of the CNS,
including the optic nerves. One of the common
early signs of MS
 is vision problems.
People with MS sometimes experience myoclonus.
Myoclonus is sudden, involuntary twitching or quivering of a muscle or group of
muscles.
It’s a reactive nerve cell misfire that sends the wrong
signal to your muscles. This could be the result of demyelinating
lesions
 from MS.
There are a variety of causes for an eye twitch in people
with MS, such as nystagmus and internuclear
ophthalmoplegia
. Other eye conditions such as optic neuritis and diplopia are also
known to affect many people with MS.
Nystagmus is uncontrolled repetitive vertical, horizontal,
or circular eye movements. This makes it nearly impossible to steadily view
objects.
Acquired nystagmus is not an uncommon symptom of MS, and
often results in diminished vision and depth perception. It also can impact
coordination and balance.
If you have visually disabling nystagmus, your doctor might
recommend medications such as:
Internuclear
ophthalmoplegia 
(INO) is damage to the nerve
fibers that coordinate both eyes in looking from side to side (horizontal movements).
Vertical eye movements are not affected.
If INO is caused by a stroke (typically in older people), it
usually only affects one eye. If it’s caused by MS (typically in younger
people), it often affects both eyes.
Some studiesTrusted
Source
 have indicated that INO is seen in about 23 percentTrusted
Source
 of people with MS and that most people will experience a
complete recovery.
For acute internuclear ophthalmoplegia, your doctor might
recommend intravenous
steroid therapy
.


A common vision problem related to MS, optic neuritis is an
inflammation of the optic nerve that can result in blurred vision,
pain, and a sudden loss of vision — typically in one eye.
Rarely causing blindness, optic neuritis might result in the
blurring of vision or a dark spot in the center of the visual field, known as a
central scotoma.
Optic neuritis commonly improves on its own, but based on
your specific situation, your doctor might recommend a steroid such as methylprednisolone administered
intravenously, possibly followed with oral steroids.

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