Skip to main content Skip to navigation

MS information for health and social care professionals Visual problems

NICE guidelines state that each professional in contact with a person with MS should consider whether the individual's vision is disturbed and this could be achieved by considering the ability to read the text of a newspaper or see television.

Optic neuritis

Optic neuritis is the most common ocular manifestation of multiple sclerosis and is characterised by an inflammation or demyelination of the optic nerve. The optic nerve is the second cranial nerve that joins the eye to the brain, transmitting the retinal image to the brain. Optic neuritis is usually transient and associated with good recovery.

The effects of optic neuritis, ie visual disturbance and ocular pain, are the first symptoms experienced by 25% of people with MS. 70% of people with MS will have optic neuritis during the course of their disease. Like MS itself, it normally affects people aged between 20 and 40 years, women more than men, and usually occurs in one eye. Not everyone who experiences optic neuritis goes on to develop further symptoms of MS, but a significant proportion do.

The visual loss associated with optic neuritis is often monocular. It occurs suddenly, is progressive and usually reaches its peak after about two weeks. Frequently there is pain, particularly during eye movement. Visual recovery takes from 4 to 6 weeks, but colour vision can be severely impaired with other minor defects often persisting. There are commonly central scotomas, which can also be persistent. A scotoma is an area of depressed visual function surrounded by an area of normal vision.

A person with optic neuritis presents with loss of vision and complains of eye pain, particularly associated with eye movement. Further investigation usually reveals defects in colour vision and central scotomas measured with a visual field analyser. On retinal inspection with an ophthalmoscope, the optic nerve head is clearly visible, and often unaffected as the inflammation is usually retrobulbar, ie on the optic nerve behind the eye rather than at the nerve head.

Double vision (diplopia)

Double vision (diplopia) may be another early symptom of MS. This occurs when the nerve pathways that control eye movements are damaged. The vision from each eye is usually normal but the person experiences double vision, often in one particular direction of gaze. If this symptom occurs as part of a relapse of MS then it will often recover, partially or fully, with the use of steroids. When the condition develops more slowly there is often little that can be done, although a patch or prism glasses may be useful.

Nystagmus

Nystagmus can also occur. This is a condition in which the eyes are seen to move in a more or less rhythmical manner, from side to side, up and down, or in a rotary manner from the original point of fixation. This sometimes goes unnoticed by the person with MS but is clearly seen by the observer. This is a difficult symptom to treat. Occasionally drug therapy can help and very recently the use of a muscle relaxant injection (botulinum) into the eye muscles has been shown to be effective.

Bibliography

  • Armstrong RA. Multiple sclerosis and the eye. Ophthalmol Physiol Opt 1999;19(Suppl 2):S32-S42.
  • Beck RW. Corticosteroid treatment of optic neuritis: a need to change treatment practices. Neurology 1992;42:1133-1135.
  • Beck RW, Cleary PA, Trobe JD, et al. The effect of corticosteroids for acute optic neuritis on the subsequent development of multiple sclerosis. N Engl J Med 1993;329:1764-1769.
  • Davis EA, Rizzo JF. Ocular manifestations of multiple sclerosis. Int Ophthal Clin 1998;38(1):129-139.
  • Frohman EM, Froham TC, Zee DS, et al. The neuro-ophthalmology of multiple sclerosis. Lancet Neurol 2005;4(2):111-121.
  • Hickman SJ, Dalton CM, Miller DH, et al. Management of optic neuritis. Lancet 2002;360:1953-1962.
  • National Institute for Clinical Excellence. Multiple Sclerosis - Management of multiple sclerosis in primary and secondary care. NICE clinical Guidelines 8. London:NICE;2003.
  • Vedula SS, Brodney-Folse S, Gal RL, Beck R. Corticosteroids for treating optic neuritis. Cochrane Database of Systematic Reviews 2007, Issue 1. Art. No.: CD001430.