Vision problems in MS can range from optic neuritis and blurred vision to double vision (diplopia), involuntary or jerky eye movements (nystagmus) or, on occasion, a total loss of sight. Complete blindness, however, is rare.

Most MS patients experience eye problems at one time or another, and for some they can be a first indication of the disease.

These symptoms generally are caused by damage to the optic nerve, which carries information between the eyes and the brain,  or from poor coordination of eye muscles so that the eyes do not move together or move well together.

Optic neuritis, a blurring or graying of vision or blind spot in one eye, results from inflammation in the optic nerve or by damage to myelin (demyelination) along the nerve. Pain and partial vision loss in one eye are common (rarely are both eyes affected), and most people generally recover from an attack.

Double vision and involuntary eye movements (horizontal or vertical) are due to lesions along the nerve pathways that control eye movement. The eyes may be out of alignment, or subject to jerky and uncontrolled movement.

Double vision, or diplopia, results from they eyes not moving together as they should, and can cause a person to see two of whatever object they’re looking at: side by side, one on top of the other, at objects that appear at angles. It may occur only when looking in certain directions, whether straight ahead or off to the side. Double vision can also cause feelings of nausea or vertigo, and affect a person’s balance.

Involuntary eye movement, or nystagmus, is a rhythmic jerkiness or bounce in one or both eyes. It often doesn’t affect vision, and many patients don’t realize they have nystagmus until it’s detected in an examination. But, in some people, these movements can affect vision, with objects appearing to move back and forth, tremble or wiggle (a condition called oscillopsia). Stress, fatigue or heat can aggravate this vision problem, as they can other eye symptoms of MS.

Treating vision problems in MS

Most vision problems eventually improve on their own, but treatments do exist for more severe symptoms.

In optic neuritis, when symptoms are particularly bothersome or affect both eyes — or if a quicker recovery is needed — intravenous steroids, such as methylprednisolone, are usually prescribed.

If double vision is impairing, patching one eye can temporarily be of help as it blocks one of the images. But an eye patch isn’t advised for long-term use as it affects the brain’s ability to correct this problem itself. Eyeglasses with special prisms may also be prescribed, although double vision is usually temporary and will clear on its own. Simply resting the eyes periodically can bring relief.

A few drugs, like clonazepam, gabapentin and baclofen, may be used to ease involuntary and jerky eye movements that are affecting vision, but not everyone is helped by them.

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