Neuro-Ophthalmologic Manifestations of Multiple Sclerosis (MS)

Neuro-ophthalmic manifestations are frequently encountered in persons with multiple sclerosis  (MS). Affected individuals may experience problems with how they see the world (afferent visual pathway symptoms) and/or how 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 MS. Some individuals with MS also experience homonymous visual field defects caused by lesions in retrochiasmal or retrogeniculate regions of the afferent visual pathway. Efferent visual pathway lesions in the central nervous system (CNS) may create a perception of oscillopsia, a visual disturbance in which objects appear to jiggle or move owing to nystagmus (involuntary eye movements). Seeing two objects instead of one (diplopia) with a binocular view can arise from ocular misalignment caused by lesions of the brainstem and cerebellum.

Because patients with MS who have visual symptoms tend to seek ophthalmic attention, 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. 

Patients with visual disturbances in the setting of a suspected or established MS diagnosis should be cautioned to avoid activities that present a safety risk to themselves or others. In some instances, this may require a patient to cease driving, at least temporarily.

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