Vision problems and multiple sclerosis
A vision problem is the first symptom of multiple sclerosis for many people. Fortunately, the prognosis is good for recovery from many vision problems associated with MS.
Three common vision problems for people living with MS are optic neuritis, diplopia (double vision) and nystagmus.
A common visual symptom of MS is optic neuritis — inflammation of the optic (vision) nerve. Optic neuritis usually occurs in one eye and may cause aching pain with eye movement, blurred vision, dim vision or loss of color vision. For example, the color red may appear washed out or gray. Vision may be lost completely in the affected eye. A blurred or dim spot (scotoma) may occur in the center of the visual field, with peripheral vision unaffected. Optic neuritis usually occurs in one eye only. It is possible that after experiencing optic neuritis in one eye, you may experience it in the other eye at some time in the future — although this does not always occur.
Optic neuritis with a loss of vision can be a frightening symptom, but in most cases, vision returns. Residual symptoms are possible, and you may notice a dimming or blurring of vision if you are very fatigued or overheated. Rest and cooling generally help vision return.
High doses of glucocorticoids, such as intravenous methylprednisolone or prednisone pills, are often used to help accelerate recovery from optic neuritis.
In MS, diplopia, or double vision, occurs when the nerves that control your eye movement are inflamed or damaged. The nerves control muscles that allow eye movement. Normally, the muscles work in a coordinated way, but when diplopia occurs, muscles on one side may be weak from nerve damage and the eye movements are no longer coordinated. This may produce two side by side images or one image on top of another. Diplopia may be temporary or persistent and may resolve without treatment. When diplopia is a new symptom, it may be part of a relapse of MS and a brief course of corticosteroids may be helpful. Patching one eye can also be useful for driving or other short tasks. Special eyeglass lenses known as prism lenses may be helpful for persistent diplopia.
Nystagmus is involuntary and uncontrolled movement of the eyes that can impair your vision. Movement is usually rapid and can be up and down, side to side or rotating. Nystagmus may occur when looking straight ahead or may occur when the eyes are moved. Sometimes nystagmus is called “dancing eyes.” It may make you feel like the world is moving and you may notice that you can hold your head at an angle to reduce the symptoms. Nystagmus may come and go or may be persistent. Treatment for nystagmus is limited and may include off-label use of medications such as gabapentin.