Multiple sclerosis (MS) is a disorder in which the immune system accidentally attacks the healthy parts of the nervous system, including the nerves that connect the eyes to the brain or those that control the muscles involved in eye movement.
As a result, many people with MS will experience vision problems, which often are one of the first symptoms noticed by patients.
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 out of what is being seen. Optic neuritis, which refers to inflammation of these 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. Others may notice a blurred or dim spot called a scotoma in the center of the field of vision. This particular condition may cause aching pain with eye movement, and some patients, in rare cases, may experience a complete loss of vision.
Symptoms of optic neuritis usually ease within a few weeks, though some issues like blurred vision may persist. It is quite rare for someone with MS to go fully blind as a result of the disease. Anti-inflammatory medications like corticosteroids may be used to help resolve bouts of optic neuritis.
Eye movement problems
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.
Such problems may result in rapid, involuntary movement of the eyes, referred to as nystagmus. These movements do not always cause any noticeable problems for the person experiencing them, though they can interfere with vision. Some patients report feeling as if the world is constantly moving, for example.
Weakness of the eye muscles can cause the two eyes to move slightly out of sync with each other, which may result in diplopia or double-vision — when a person sees two of everything. This can appear as two side-by-side images, or seeing images overlaid on top of each other.
Certain anti-seizure medications, like clonazepam, gabapentin, and baclofen, may help to manage eye movement problems. Eyeglasses with special prisms may help manage double-vision if it is a persistent problem.
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 not fully understood; it broadly is thought to result from the altered activity of neuronal proteins at high temperatures.
Uhthoff’s syndrome usually resolves on its own once the person rests and their body temperature cools down. Management usually focuses on avoiding increases in body temperature and finding convenient ways to cool down. Medications such as Ampyra (dalfampridine) also may be used to manage the condition.
Last updated: Jan. 18, 2022, by Marisa Wexler MS
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