Vision problems are prevalent among people with multiple sclerosis (MS). Visual symptoms can be early indicators of MS and often motivate people to seek medical treatment.
“The symptom that made me pay enough attention to go to the doctor was my vision change,” one MyMSTeam member wrote. Visual problems can also occur in people who have had MS for longer periods of time.
As with other MS symptoms, everyone experiences vision problems a little differently. Here’s how members of MyMSTeam have described the vision and eye problems they have experienced:
Diplopia, or double vision, can be an early symptom of MS. Diplopia in people with MS is related to damage to the nerves that control eye movement. This causes a misalignment in the eyes. Diplopia is sometimes temporary. In other cases, it is persistent.
Nystagmus is a vision problem that causes the eyes to move from side to side in a repetitive, uncontrolled manner. It is sometimes called “dancing eyes.” Nystagmus also can prevent a person from holding a steady gaze. This can cause or worsen dizziness and nausea, which can contribute to balance issues and falls. Nystagmus may be persistent, or it may come and go.
MS can damage the nerves in the cerebellum or brain stem of the central nervous system and cause nystagmus. The cerebellum and the brain stem are both regions of the brain responsible for muscle movement, vision, and balance. Nystagmus may also be caused by optic nerve damage. Damage to the optic nerve disrupts the interpretation of visual information.
Eye floaters are relatively common among people with MS and vision problems. Eye floaters are dots in your vision that go away or move with your eye if you try to look at them. There may be one or many of them. Although they often appear as small dots, they can also show up as rings, lines, or other shapes.
Eye floaters can be caused by normal aging — or by uveitis, inflammation of one of the eye layers. In the most common form of uveitis, inflammation is concentrated on the peripheral retina. They are not harmful, but eye floaters can cause persistent vision issues if they make it difficult to see fully.
Optic neuritis is one of the common symptoms of MS, and it’s often one of the first symptoms of the condition. “People experience blurred vision in one or both eyes and often also experience pain with eye movements,” explained Dr. Jacqueline Nicholas, a neurologist and MS specialist at the OhioHealth Multiple Sclerosis Clinic in Columbus, Ohio.
Another symptom is a scotoma — a blurry, dim, or blind spot. A scotoma may occur in the center of the visual field without changing peripheral vision. Optic neuritis may also affect color vision and make colors appear gray.
Optic neuritis is linked to neuromyelitis optica, a rare condition that can cause blindness and paralysis. Treatments to prevent future attacks of neuromyelitis optica are different from treatments used to prevent MS relapses, so an accurate diagnosis of vision problems is important.
When optic neuritis occurs in someone with MS, it’s often due to inflammation of the optic nerve and demyelination. “It’s caused by an immune attack of someone's own white blood cells attacking the myelin coating on the optic nerve,” said Dr. Nicholas.
Optic neuritis is the first MS symptom for 1 in 4 people with MS, according to Multiple Sclerosis Trusts. As many as 7 out of 10 people with MS will experience optic neuritis at some point, according to the nonprofit.
Optic neuritis doesn’t only affect people with MS. Between 1 and 5 people in 1,000 in the general population are affected by optic neuritis, per Multiple Sclerosis Trust. Much like MS, optic neuritis tends to affect more women than men and develops between the ages of 20 and 40.
In people with MS, optic neuritis can occur regardless of the type of MS they have. According to Dr. Nicholas, “We see optic neuritis in relapsing MS because it typically comes on in the form of a relapse.” People who have secondary progressive MS also can develop optic neuritis.
The prognosis for recovery is promising for many MS-related vision problems. “For many people with optic neuritis, it often improves with time, although improvement may not be complete,” explained Dr. Nicholas. “The good news is that there are options to help individuals with decreased vision often offered through low-vision clinics.”
Treatment options for vision problems include steroids at the time of onset, plasmapheresis, and specialized lenses.
High doses of steroids, such as methylprednisolone (Solu-Medrol), are often the go-to treatment for an episode of optic neuritis in people with MS. They are commonly delivered intravenously (through a vein). Dr. Nicholas said the dosage is “usually a gram of that once a day for anywhere between three to five days.” High-dose oral steroids can also be used to treat optic neuritis.
Eye floaters are usually considered harmless and are not treated by doctors. In extreme cases when they are significantly affecting vision, some doctors will recommend surgery to try to remove them.
However, there are steps you can take to help alleviate the problems floaters cause, including wearing sunglasses when outside and protective eyewear in bright light. Resting your eyes frequently can also reduce the negative effects of eye floaters and help you see properly.
Nystagmus is more complicated than other MS-related vision problems. There are fewer treatment options to address the involuntary eye movements associated with nystagmus. Sometimes, eyeglasses or contact lenses can help slow the uncontrolled movements of the eyes and improve a person’s vision. Drugs like gabapentin (Neurontin) may be used to lessen eye movement or reduce twitching.
In rare instances, surgery is used to address nystagmus. Surgery, however, does not directly address the eye symptoms associated with nystagmus.
When double vision occurs due to an MS relapse, it often resolves itself partially or fully. Treatment with steroids can hasten this recovery. Some people wear a patch over one eye to help with diplopia.
A Fresnel prism is a special lens attached to a person’s glasses. It may adjust the way light enters a person's eyes. In some instances, a Fresnel prism can help realign the two images in double vision by altering the way visual information enters the eye.
Sometimes, double vision persists for extended periods of time. In these cases, Botulinum toxin (Botox) or surgery may be used to help bring the eyes back into proper alignment and to adjust the affected eye muscles.
By joining MyMSTeam, the social network and online support group for those living with multiple sclerosis, you gain a support group of more than 192,000 members strong. Vision problems are one of the most discussed topics; more than 17,000 MyMSTeam members experience vision issues.
Have you experienced vision problems related to MS? Do you get eye floaters or blurred or double vision? Share your experiences in the comments below or directly on MyMSTeam.