Understanding the Impact of Multiple Sclerosis on Vision

With Multiple Sclerosis (MS), the immune system mistakenly attacks and damages the protective covering (myelin) around nerve fibers in the CNS. This damage disrupts the normal flow of electrical impulses along the nerves and can cause a wide range of symptoms, including vision problems.

Understanding the Impact of Multiple Sclerosis on Vision Optometrist
Specialty Vision

Optic neuritis and Multiple Sclerosis 

Optic neuritis is an inflammation of the optic nerve, which can cause various symptoms that affect vision. Some of these symptoms may occur suddenly, while others may develop gradually over time. Optic neuritis can be a common symptom of multiple sclerosis (MS), however, optic neuritis can also occur as a result of other conditions or infections. If you experience any of the symptoms of optic neuritis, it is important to seek medical attention promptly to prevent further vision loss or complications.

According to the Multiple Sclerosis Trust, approximately 70% of individuals with MS will experience optic neuritis at some point during the course of the disease.

The optic nerve, which connects the eyes to the brain, can be impacted by optic neuritis when the protective myelin sheath surrounding it is damaged. With the progression of MS, this demyelination can worsen.

Symptoms of optic neuritis may include: 

  • Blurry or hazy in the central or peripheral field
  • Loss of vision
  • Decreased visual acuity
  • Impaired color vision
  • Pain in the eye
  • Eye discomfort
  • Eye redness
  • Photophobia (sensitivity to light)
  • Scotoma (blind spot)
  • Visual field defects
  • Double vision
  • Nystagmus (involuntary eye movements)
  • Diplopia (double vision)
  • Ocular pain with eye movement
  • Reduced contrast sensitivity
  • Visual snow (static or flickering visual disturbance)
  • Halo effect around bright lights
  • Difficulty reading
  • Visual distortions
  • Tinnitus (ringing in the ears).
  • Eye fatigue
  • Headaches

The exact duration of optic neuritis can vary among individuals, but most people experience improvement in their vision within several weeks of onset. However, complete recovery of vision can take several months or more, and some people may experience ongoing visual problems or permanent vision loss.

Double vision and Multiple Sclerosis

Double vision and Multiple Sclerosis

While it is difficult to determine the exact incidence of double vision in people with MS, the National MS Society estimates that up to 70% of people with MS experience vision problems, and about 20% of those people experience double vision. 

Double vision from MS can be caused by nerve damage to the muscles that control eye movement. Normally, both eyes transmit similar information to the brain, where it is combined and processed into a clear and three-dimensional image. However, when MS damages the nerves in the brainstem responsible for controlling eye movements, the eyes can move independently of each other, resulting in two separate images being sent to the brain, causing double vision.

While persistent double vision can be a long-term effect of progressive MS, it is possible for the condition to resolve on its own in some cases.

Is blurry, fuzzy, or double vision impacting your quality of life and vision? Take our online double vision assessment 

Double vision and Multiple Sclerosis

Double vision and Multiple Sclerosis

Nystagmus is a visual condition that can occur as a result of MS affecting the inner ear or the cerebellum, the part of the brain responsible for coordination.

This condition involves repetitive and involuntary eye movements that give the sensation of eye-jerking or jumping, and can result in dizziness and nausea. Nystagmus can happen while looking in a specific direction or while engaging in certain activities.

MS can also cause oscillopsia, a feeling that the environment is moving back and forth or up and down.

Dry Eye and Multiple Sclerosis

Dry Eye and Multiple Sclerosis

As an optometrist dealing with both multiple sclerosis and dry eye, it is important to note that individuals with Multiple Sclerosis (MS) may experience severe dry eye as a common symptom. MS can cause damage to the nerves that control tear production, leading to decreased tear production and subsequent dry eye symptoms. Additionally, MS can cause inflammation of the meibomian glands that produce the oily component of tears, further contributing to dry eye symptoms.
Take our dry eye assessment to see if your symptoms indicate that you are suffering from treatable dry eye disease

Enhancing Vision in Patients with Multiple Sclerosis: A Guide to Treatment Options

Visual conditions resulting from multiple sclerosis (MS) are treated differently based on their cause, type, and severity. A personalized treatment plan is determined by our eye doctor based on the individual's symptoms and overall health. Normally a neuro optometrist will coordinate the patient's care with other members of the care team.

Neuro Optometric Rehabilitation 

Neuro optometric rehabilitation helps improve vision and overall function in individuals with multiple sclerosis. This may include exercises to improve eye movements and strengthen eye muscles, as well as using filters and prisms to address specific symptoms. A neuro optometrist has extensive training and experience working with neurological conditions such as multiple sclerosis. Learn more about neuro optometric rehabilitation.

Low Vision and Assistive devices

Assistive devices, such as magnifying glasses, filters, and specialized lenses can be used to improve vision and reduce discomfort in individuals with multiple sclerosis. These devices can help magnify objects, reduce fatigue, improve contrast, and reduce glare. Learn more about low vision devices.

Dry Eye Treatment

It is important for individuals with MS who experience dry eye to speak with our eye doctor about treatment options, which may include the use of artificial tears, steroids, medications such as Restasis or Xiidra, punctal plugs, amniotic membranes, heating and expressing glands, and scleral lenses.  It is also important for individuals with MS to have a full dry eye workup before attempting treatment to identify the underlying cause of dryness. 

While dry eye is extremely common in patients with MS, there is some evidence of a higher incidence of Sjorgen’s in those with MS, and Sjorgens presents similar symptoms of dry eye. Learn more about dry eye treatment.

Anti Inflammatory medication

Corticosteroids are powerful anti-inflammatory drugs that are often used to treat various symptoms of multiple sclerosis, including visual conditions. They work by reducing the inflammation and swelling in the central nervous system that can cause vision problems.

Plasma exchange therapy

Plasma exchange therapy, also known as plasmapheresis, is a procedure that removes the plasma (the liquid part of the blood) and replaces it with fresh plasma or a plasma substitute. This therapy is sometimes used to treat visual conditions caused by multiple sclerosis as it can help reduce inflammation and improve vision.

Immunomodulatory drugs

Immunomodulatory drugs work by altering the immune system's response to the central nervous system. These drugs are often used to treat multiple sclerosis and can help reduce inflammation and improve vision. Some of the most common immunomodulatory drugs used for multiple sclerosis include interferon beta, glatiramer acetate, and natalizumab.

Optic nerve sheath decompression surgery

Optic nerve sheath decompression surgery is a procedure that involves removing a small piece of the protective sheath around the optic nerve to relieve pressure and improve blood flow. This surgery is sometimes used to treat visual conditions caused by multiple sclerosis that are not responding to other treatments.

Antiviral drugs

In specific cases, antiviral drugs may be used to treat visual conditions caused by multiple sclerosis. These drugs are used to treat infections that may contribute to vision problems, and may also help reduce inflammation and improve vision.

Double vision and Multiple Sclerosis

Common Questions

Multiple sclerosis (MS) can cause various symptoms, including blurry vision. The duration and extent of symptoms can vary greatly among individuals with MS. In some cases, symptoms may resolve on their own, while in others they may persist or progress over time. The recovery or resolution of symptoms often depends on several factors, including the type and severity of MS, the individual's overall health, and the effectiveness of treatments. In some cases, vision rehabilitation or other interventions may help improve vision or manage related symptoms. Consultation with our neuro optometrist can provide a more personalized assessment and management plan for individuals with MS-related vision problems.
No, an eye exam cannot detect Multiple Sclerosis (MS). An eye exam is used to assess the health of the eyes and visual system, but it cannot diagnose MS, which is a chronic autoimmune disease that affects the central nervous system. To diagnose MS, a doctor will conduct a comprehensive medical evaluation, including a review of the patient's symptoms and medical history, a physical exam, and possibly imaging tests such as an MRI, and possibly a lumbar puncture. In some cases, an eye exam may reveal changes in the optic nerve that are indicative of MS, but it is not a definitive diagnostic tool for the disease.
Understanding the Impact of Multiple Sclerosis on Vision
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Schedule a neuro-optometric exam for vision issues caused by multiple sclerosis

We understand the challenges that visual conditions caused by multiple sclerosis can present. We strongly encourage you to schedule a neuro-optometric evaluation to ensure that your eyes are receiving the proper care and attention they deserve. During this comprehensive exam, we will assess the unique needs of your eyes and work with you to develop a personalized treatment plan. Early detection and intervention are key in managing visual issues caused by multiple sclerosis, so don't hesitate to take control of your vision today.