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.
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.
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.
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 for nystagmus are limited and may include the use of certain anticonvulsant (anti-seizure) medications or muscle relaxants such as:
These therapies can potentially help reduce eye twitching and jerky movements.
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.
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, 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.
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. Medications such as Ampyra (dalfampridine) also may be used to manage the condition.
Given the variability of MS symptoms and signs, each patient will have a different experience with vision problems. Some eye disorders associated with MS can be temporary and resolve — partially or fully — on their own. That is usually the case if these vision disturbances occur as part of a relapse (when MS symptoms suddenly worsen). In contrast, other vision problems can become persistent.
For example, symptoms of optic neuritis usually ease within a month or two, typically four to six weeks, though some signs like blurry vision may persist.
Nystagmus can be a recurrent symptom, one that comes and goes, for MS patients, but it also can become a persistent eye sign. Patients with a progressive form of MS are more likely to experience persistent visual problems, a 2013 study on visual disturbances in MS suggested.
Vision problems in MS patients, especially if persistent, can contribute to dizziness and lack of coordination, which can affect balance and increase the risk of falls.
General MS treatment with disease-modifying therapies also can have a beneficial effect on eye complications and help restore normal vision.
Eye exams can identify MS and eye-related complications. In fact, because vision disturbances are a common first symptom of the disease, some MS cases may be initially detected through a routine eye exam.
Some specific eye exams, such as optical coherence tomography (OCT), are particularly useful in MS diagnosis and disease monitoring. OCT is a non-invasive imaging technique that uses light waves to provide high-resolution images of layers in the eye’s retina — the back part of the eye that contains the cells that sense light and the nerve cells that transmit signals from the eyes to the brain.
The technology helps to differentiate between each retinal layer and enables measurements of the thickness of each. Of note, thinning of certain retinal layers can indicate neurodegeneration; MS patients often exhibit a thinner retinal nerve fiber layer when compared with healthy individuals.
Another eye exam, called the visual evoked potential (VEP) test, can measure the electrical activity of the optic nerves and detect abnormalities in how the brain responds to visual stimuli. A slower transmission of electrical signals from the eyes — as little as a few milliseconds — can indicate nerve damage and help in the diagnosis of MS.
MRI with contrast dye, another imaging technique, also can be employed to look for areas of inflammation or damage in the optic nerves. Such scans also can rule out other potential causes of visual disturbances, including tumors.
MS can cause blindness in some patients, even if temporarily. This loss of vision can be partial or full. It is, however, quite rare for someone with MS to go fully blind as a result of the disease. In advanced stages, and in cases where the disease attacks the optic nerves or other parts involved in vision, permanent changes in eyesight may occur.
Multiple Sclerosis News Today is strictly a news and information website about the disease. It does not provide medical advice, diagnosis, or treatment. This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website.
Multiple sclerosis can cause vision problems due to damage to the optic nerves — those that connect the eyes to the brain — or to nerves that control the muscles involved in eye movement, which affects eye coordination. These nerves get damaged in MS due to a misguided immune attack against myelin, the fatty coating that protects and insulates nerve fibers.
Several abnormalities in vision have been linked to multiple sclerosis, and are, in fact, common early signs of the disease. Vision problems reported in MS patients include optic neuritis, or inflammation of the optic nerve, double vision, called diplopia, blurred vision, color blindness (poor or deficient color vision), and rapid, uncontrolled eye movements known as nystagmus. Loss of vision may sometimes occur. Some eye conditions associated with MS are temporary and resolve on their own, while others can become persistent.
Yes, multiple sclerosis can cause dry eyes. The condition, which may become severe, is thought to derive from a reduced sensitivity in the cornea (the transparent, outer, protective covering of the eyeball), reduced eye motor responses to stimuli, including a reduction in tear production, and/or increased air exposure due to muscle limitations that interfere with blinking.
Yes, multiple sclerosis can cause a person to see flashing lights — bright spots, or points of light in the field of vision, often referred to as phosphenes. Phosphenes in MS can last for a few seconds or be permanent, and are generally more noticeable in the dark. These flashing lights are frequently linked to optic neuritis, or inflammation of the optic nerve, but also may be associated with other eye problems.
Yes. About two-thirds of people with multiple sclerosis develop visual disturbances at some point in their lives, implying that others can have the disease without experiencing eye symptoms. However, eye-related complications are common in MS patients, and having regular eye examinations is recommended for people with MS.
Get regular updates to your inbox.