Vision Problems With MS

Trouble with your vision is one of the most common symptoms of multiple sclerosis (MS). It is also one of the first symptoms you may have before a doctor even diagnoses you with the condition.

Understanding common vision problems in people living with MS and how they are diagnosed and treated can help you get the care you need.

What types of vision problems happen with MS?

Vision problems related to multiple sclerosis vary from person to person and range from mild to severe. They include:^1-3

• Optic neuritis – Optic neuritis results from injury of the optic nerve. This is the nerve that carries signals from your eyes to your brain. MS attacks the protective covering (myelin) surrounding the optic nerve. This can cause blurry or cloudy vision, dull colors, flashing lights, and pain with eye movements. Optic neuritis affects 70 percent of people living with MS and can be one of the first signs of the illness.
• Diplopia – Also known as double vision, diplopia causes you to view 1 object as 2 images. This can result from injury to the nerves that help control eye movement. There are 2 types of diplopia: binocular and monocular. Binocular diplopia occurs when both eyes are open and goes away when 1 eye is closed or covered. Monocular diplopia is when double vision occurs only in 1 eye or when only 1 eye is open.
• Nystagmus – Rapid, uncontrolled eye movements are the symptoms of this condition. Looking in a certain direction may also make you feel dizzy and sick to your stomach. Another common symptom is feeling like the world is wobbly, a side effect called oscillopsia.
• Vision loss – As MS progresses, vision problems are likely to get worse without treatment, possibly leading to lasting vision loss.

How are MS vision problems diagnosed?

An eye doctor with neurology expertise (neuro-ophthalmologist) will examine you and gather your medical history. They may also run these tests to figure out if you have a vision problem:2

• Eye exam – Your vision and power to see colors will be tested by your eye doctor.
• Ophthalmoscopy – Your doctor will use a light to view the back of your eye. They are looking for swelling in the optic disk (the point where optic nerves leave the retina). This is a sign of optic neuritis. Optic disk swelling happens in 1 out of every 3 people with the condition.
• Pupillary light reaction test – This test checks how your pupils react to light. Usually, pupils shrink in bright light, but they will stay somewhat open with optic neuritis.
• Visual evoked potentials (VEPs) – This test measures your brain’s signals in response to visual triggers. You watch visual patterns on a screen for several minutes while electrodes placed on your scalp record your brain signals. Certain patterns can identify damaged nerves in the optic nerve.
• Optical coherence tomography (OCT) – This test uses light to take images of the back of your eyes, including the optic nerves. This can help detect subtle evidence of prior optic nerve injury. Some neurologists use this to help diagnosis and track the progression of MS.

How are MS vision problems treated?

Treatment for MS-related vision problems depends on a few factors. Your doctor will look at your specific eye condition, how far it has advanced, and whether the condition has responded to other therapies. Treatments may include:^1,2

• No treatment – Most of the time, optic neuritis will get better without treatment.
• Steroids – If your optic neuritis symptoms do not disappear, your doctor could suggest prescription steroids to ease inflammation in the optic nerve. Steroids can also help other eye symptoms, such as double vision, improve faster.
• Plasma exchange therapy (plasmapheresis) – This procedure involves replacing your blood’s plasma with the plasma of a donor. The idea is to “flush out” certain proteins in the plasma that may cause MS attacks. Researchers are not sure whether plasma exchange therapy improves optic neuritis.
• Eye patch – Wearing a patch over 1 eye may ease dizziness and nausea triggered by double vision.
• Prism prescription glasses – Special glasses with prisms that bend light can correct or improve chronic stable double vision for some people.
• Other prescription drugs – Klonopin (clonazepam) has been shown to relieve symptoms of nystagmus. And, early research shows over-the-counter antihistamines may improve visual symptoms caused by optic nerve damage.
• Avoiding triggers – Just like other MS symptoms, fatigue, overuse of the eyes, being hot, and stress can worsen MS vision symptoms in some people. Avoid or minimize these triggers when possible.