- Author: Fiona Costello, MD, FRCP; Chief Editor: Hampton Roy, Sr, MD more..
Practice Essentials
Neuro-ophthalmologic manifestations are frequently encountered in persons with multiple sclerosis (MS) and other central nervous system (CNS) inflammatory disorders, including neuromyelitis optica spectrum disorders (NMOSDs) and myelin oligodendrocyte glycoprotein IgG-associated disease (MOGAD).
Affected individuals may experience problems with how they see the world (afferent visual pathway symptoms) and/or how smoothly their eyes move together (efferent visual pathway disorders). Optic neuritis is an inflammatory injury of the optic nerve that causes vision loss, which is common in patients with MS and other CNS inflammatory disorders. In fact, approximately 20% of patients with MS present with optic neuritis as the first clinical disease manifestation. [1] The annual incidence of optic neuritis is 1-5 per 100,000 per year. [2] The majority of optic neuritis cases encountered in clinical practice are either sporadic or MS related. At a population level, optic neuritis associated with neuromyelitis optica spectrum disorders (NMOSDs) and myelin oligodendrocyte glycoprotein IgG-associated disease (MOGAD) accounts for 9% of optic neuritis cases. [3]
Some individuals with MS and other CNS inflammatory syndromes may also experience homonymous visual field defects caused by lesions in retrochiasmal or retrogeniculate regions of the afferent visual pathway.
Seeing 2 objects instead of 1 (diplopia) with a binocular view can arise from ocular misalignment caused by lesions in the brainstem and cerebellum.
Because patients with MS and other CNS inflammatory disorders who have visual symptoms often seek ophthalmic attention for those symptoms, eye care experts play a vital role in the localization of visual disturbances that may either represent the first clinical manifestation of MS or affect individuals with established diagnoses.