Optic neuritis is an inflammatory eye condition that causes eye pain and temporary vision loss. Optic neuritis is the first sign of multiple sclerosis (MS) in about 15 percent to 20 percent of people with MS. About half of all people with MS will develop optic neuritis in their lifetimes.

In this article, we describe optic neuritis, including its causes and symptoms, and discuss how it’s diagnosed and treated in people with MS.

How Eye Pain Led to My MS Diagnosis

David Wallis shares how double vision led to his MS diagnosis and how he learned to manage symptoms and adapt.

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Transcript

00:00:00:27 - 00:00:18:06
David Wallis
Here I am out golfing, I see double vision and boom, I have this life-altering MS diagnosis. Hey, go golfing and find out you have a life-altering disease. Happy, happy.

00:00:18:08 - 00:00:49:01
David Wallis
I was with my roommate/best man at my wedding, and I’m looking at the flagstick and boom, two flags right next to each other. It was definitely double vision I was having. I just had kind of had to adjust and walked around with one eye open, so I didn’t trip and fall and lose my balance. So I saw the neurological ophthalmologist, and he did about six months’ worth of tests before he finally said, “You have all the indicators that this is multiple sclerosis.”

00:00:49:06 - 00:01:07:25
David Wallis
There were probably things I could do. I could get an eye patch and whatnot, but I felt that that would kind of call out attention to myself. It wasn’t preventing me from doing stuff. If I was in a meeting or talking to someone, I just dealt with the double vision. Basically, I just had to close one eye and boom, you’re not having double vision anymore.

00:01:07:26 - 00:01:27:16
David Wallis
You can see normal. If someone was having symptoms of double vision, they should most definitely ask their doctor, “What can we do to accelerate the easing of this flare?” I highly recommend using an eye patch or something else that would cover up. That would certainly be a way outside of, you know, doing what I did, which is just close one eye.

00:01:27:21 - 00:01:43:29
David Wallis
It’s definitely manageable. You have to make some adjustments. You have to make light of it because otherwise, you know, you have depression and whatnot. I refuse to go down that hole. Learn more and connect at MyMSTeam.com.

What Causes Optic Neuritis?

The cause of optic neuritis isn’t well understood. Researchers believe optic neuritis may be caused by an inflammatory response from certain bacterial infections, viral infections, or autoimmune diseases such as MS. Optic neuritis is also associated with two rare conditions of the eyes and nervous system called:

• Neuromyelitis optica spectrum disorder (NMOSD)
• Myelin oligodendrocyte glycoprotein (MOG) antibody disorder

In MS, the immune system attacks the myelin, a protective coating that surrounds the nerves within the central nervous system (brain and spinal cord). The optic nerve sends signals from the eyes to the brain, allowing people to make sense of what they see. If the optic nerve becomes inflamed, it can’t send signals to the brain effectively. Within hours or days of developing this demyelinating condition, an individual may not be able to interpret visual images clearly or may experience vision loss.

Who Is More at Risk for Optic Neuritis?

According to the Multiple Sclerosis Trust, optic neuritis affects more women than men. Symptoms typically appear in people who are between 20 and 40 years old.

Symptoms of Optic Neuritis

Optic neuritis symptoms typically happen suddenly and in one eye. They can cause blind spots (known as scotomas) or areas of poor vision. Symptoms vary depending on the severity of optic nerve damage, but vision loss is typically the main symptom.

Other symptoms include:

• Diplopia (double vision)
• Blurred vision
• Eye pain with eye movement in one or both eyes
• Nystagmus (involuntary movement of the eyes)
• Pain in the back of the eye socket
• Decreased visual field
• Deficiency or loss of color vision
• Flashes of light
• Pupil abnormalities (shape, size, and reaction to light)
• Swelling of the optic disc

Symptoms of optic neuritis can vary widely, and even severe symptoms can resolve over time. It’s also possible to have swelling or inflammation of the optic nerve without it ever affecting a person’s vision.

If you begin to experience eye problems, specifically double vision or nystagmus, see an ophthalmologist, neurologist, or neuro-ophthalmologist right away.

Diagnosing Optic Neuritis

One MyMSTeam member shared their story with optic neuritis and an MS diagnosis: “After having headaches and eye pain for seven days, I went to see my ophthalmologist. He said I had optic neuritis. Then, I saw a neurologist the next week, and he diagnosed me with multiple sclerosis. I remember those first weeks being very grueling and exhausting.”

It’s crucial to seek medical advice and get an eye exam as soon as symptoms of optic neuritis occur. Your doctor may perform the following tests.

Funduscopic or Ophthalmoscopic Exam

An ophthalmoscopic eye exam allows the doctor to evaluate the optic disc in the back of the eye. The optic disc is where the optic nerve enters the retina. About one-third of people with optic neuritis have swelling in their optic disc.

Pupillary Light Reaction Test

A pupillary light reaction test can be used to observe pupillary responses to bright light, as well as pupil size and shape. Pupillary response abnormalities are a common symptom of optic neuritis. Pupils typically will not constrict (get smaller) when exposed to bright light.

Other Tests

Other tests to diagnose optic neuritis might include:

• Blood tests to check for infections
• An AQP4-immunoglobulin G (IgG) antibody test for NMOSD
• A MOG-IgG test for MOG antibody disorder
• An MRI scan of the brain to check for lesions
• Optical coherence tomography testing to measure retina thickness
• Visual field tests to measure peripheral vision
• Visual evoked response testing to examine electrical signals sent to the brain

Treating Optic Neuritis

Treatment for optic neuritis will depend on the cause and the severity of your symptoms.

If optic neuritis symptoms are mild, the condition typically can improve on its own. However, if symptoms are severe or begin to interfere with daily activities, treatment can help ease symptoms, improve vision, or slow the progression of the disease.

The most effective treatment to improve visual problems in optic neuritis involves corticosteroids, often simply known as steroids. Steroid treatment can help reduce inflammation and prevent optic nerve damage. Steroids such as methylprednisolone may be administered intravenously (by IV) at first, followed by a course of high-dose oral steroids like prednisone.

Studies have shown that IV and oral high-dose steroids have the same treatment outcomes, although IV steroids may speed recovery time.

It’s important to note that research has found that low-dose oral prednisone alone isn’t effective for treating optic neuritis. In fact, it may actually increase the risk of optic neuritis episodes.

Therapeutic plasma exchange, also called plasmapheresis, is another treatment option if steroid treatment isn’t effective.

The majority of people diagnosed with optic neuritis recover well. About 80 percent of people report improvement in their vision problems within two or three weeks from their first symptoms.

Living With Optic Neuritis and MS

People with MS may experience flare-ups or relapses of optic neuritis that affect one or both optic nerves. Some optic neuritis side effects can affect a person’s sense of balance and contribute to mobility challenges from MS.

Most people with optic neuritis and MS tend to recover and regain their vision within a few weeks or months. However, some people need up to a year to recover.

While you’re recovering, you’ll want to make sure you can function safely with reduced vision. Some ways to help prevent accidents when experiencing vision changes include:

• Using a cane or mobility aid when walking to prevent falls or balance problems
• Carrying a flashlight when you go out at night
• Organizing your possessions at home, school, or work so they are easy to find
• Making sure your home or work areas are well lit
• Marking light switches, doorways, and steps with paint or colored tape
• Using a large-print version of books, magazines, newspapers, telephone dials, or calendars
• Using other low-vision aids, such as magnifiers and talking watches

In addition, wearing an eye patch on the affected eye can help reduce double vision without delaying your recovery or affecting your vision.

“I was flying back home by myself and having trouble with double vision. I wore an eye patch, and it worked great,” said one MyMSTeam member.

Another member wrote, “My doctor said I could wear an eye patch for short periods of time. It helped me feel less nauseous since the vision loss was so sudden.”

Staying Positive

Your quality of life is important. Living with optic neuritis and MS can lead to depression and anxiety that make it harder to enjoy life. They can even make MS symptoms worse.

Here are some things that can help:

• Get regular physical activity.
• Make time for hobbies you enjoy.
• Get together or have a phone call with a loved one.
• Ask your doctor for referral to a counselor.
• Consider medication such as antidepressants.

“I try to stay positive every day,” wrote one MyMSTeam member. “Rest if you need to. Watch funny movies. Listen to calming music. Do whatever brings you joy.”

It’s also important to remember that you’re not alone.

“I’m definitely not feeling warrior-ish today, but it’s OK,” another member said. “It’s OK if you don’t either. Take a deep breath, and don’t suffocate.”

Join the Conversation

On MyMSTeam, people share their experiences with MS, get advice, and find support from others who understand.

Have you experienced an episode of optic neuritis? Let others know in a comment below.