MS vision problems: Common eye symptoms

Multiple sclerosis (MS) is a disorder that occurs when the immune system accidentally attacks healthy parts of the central nervous system, including the nerves that connect the eyes to the brain, and those that control the muscles involved in eye movement.

As a result, many people with MS experience vision problems in the affected eye. In fact, eye problems often are one of the first MS symptoms noticed by patients.

Common vision problems associated with MS

Optic neuritis

The optic nerves connect the eyes to the brain, transmitting visual data recorded by the eyeballs to parts of the brain that can process and make sense of what is being seen. Optic neuritis, which refers to inflammation of the optic nerves, is a common symptom of MS, affecting about 70% of patients at some point in their lives.

Optic neuritis usually affects one eye at a time, and can result in a number of vision problems. For instance, some people may notice a dimming or “washing out” of colors — a condition referred to as color blindness, marked by poor or deficient color vision. Others may notice a blurred or blind spot called a scotoma in the center of the field of vision.

The condition also may cause aching pain with eye movement, and in rare cases, some patients may experience a complete loss of vision.

Treatment options

Anti-inflammatory medications such as glucocorticoids, a type of corticosteroid, may be used to help resolve bouts of optic neuritis — in most cases, these include intravenous (into-the-vein) methylprednisolone injections or prednisone pills.

Nystagmus

The nervous system is critical for governing muscle movements. In MS, nerve damage can result in motor problems such as spasticity, when muscles become abnormally tight over time, or cause problems with the muscles that control eye movements.

These issues may result in rapid, involuntary, and uncontrolled movement of the eyes, referred to as nystagmus. This eye twitching, or eye movement, which can be side to side, up and down, or in a circular motion, does not always cause noticeable problems for the person experiencing it, though they can interfere with vision. Some patients with such jerky, moving eyes report feeling as if the world is constantly moving, for example, or may experience nausea.

Treatment options

Treatment options for nystagmus are limited and may include the use of certain anticonvulsant (anti-seizure) medications or muscle relaxants such as:

• gabapentin
• baclofen
• clonazepam
• memantine

These therapies can potentially help reduce eye twitching and jerky movements.

Diplopia

Weakness of the eye muscles can cause the two eyes to move slightly out of sync with each other (misalignment of the eyes), which may result in diplopia, commonly known as double vision — when a person sees two of everything. This can appear as two images side by side, or seeing images overlaid on top of each other.

Treatment options

If it is a persistent problem, eyeglasses with special prisms that realign the two images may help manage double vision. Treatment with a short course of corticosteroids also may be beneficial to help ease inflammation and accelerate recovery.

Uhthoff’s syndrome

Uhthoff’s syndrome, also called Uhthoff’s phenomenon or Uhthoff’s sign, refers to a worsening of MS symptoms when the body’s temperature gets higher than normal. This can occur due to a fever, or when a person is exercising or taking a hot bath, or if the weather is especially hot. Although the term can apply to any MS symptoms that worsen when body temperature rises, Uhthoff’s syndrome usually is used in reference to worsening vision problems.

The condition is named after German neuro-opthamologist Wilhelm Uhthoff, who published the first descriptions of the phenomenon in the late 1800s. The underlying biological mechanisms of Uhthoff’s syndrome are still not fully understood.

Treatment options

Uhthoff’s syndrome usually resolves on its own once the person rests and the body temperature cools. Management usually focuses on avoiding increases in body temperature and finding convenient ways to cool down, including the use of cooling devices or garments, taking cold showers, and drinking cold beverages.

How long do MS vision problems last?

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