Eye Complications Associated with Multiple Sclerosis
The National Multiple Sclerosis Society estimates that over 2.3 million people in the world have Multiple Sclerosis, and the MS Society estimates that over 100,000 people with MS in the UK, with approximately 5,000 people diagnosed with the condition each year.
This disease, which causes the myelin that protect our nerve cells to be damaged, affects the entire body. The eyes, with their fine network of nerves, can be affected as well. Understanding the disease itself and how it can affect your vision are both integral aspects of living with an MS diagnosis.
What Exactly is Multiple Sclerosis?
Understanding medical terminology can be confusing and overwhelming for some people, and a diagnosis of any disease can be frightening. It's important to understand your disease in full to participate in your own care properly. In simple terms, multiple sclerosis is an autoimmune disease. This means your immune system is actively attacking part of your own body. On your nerves are cells that are coated in myelin. When you have MS, this coating is damaged because your immune system is attacking it. This makes the nerves not work properly, which can cause issues with just about all movement.
What Are the Symptoms of Multiple Sclerosis?
As the entire body is controlled by the central nervous system (CNS), symptoms can appear almost anywhere in the body. With that said, some of the most common symptoms include:
- Overwhelming fatigue that isn't resolved by plenty of rest.
- Altered sensations, such as stabbing pains or a feeling or warmth or tingling anywhere on the skin.
- Mobility issues, such as staggering or an increase in clumsiness.
- Visual disturbances, such as halos, tunnel vision or problems discerning light patterns.
MS can sometimes be difficult to diagnose because symptoms vary so greatly from one person to another and even within the same patient over time. Symptoms may change, or fade and come back again. This can make treatment a frustrating series of trial-and-error, as the disease has no set progression.
Does Multiple Sclerosis Cause Paralysis?
Multiple sclerosis does not always result in becoming paralyzed. In fact, two thirds of MS patients retain the ability to walk. Some do need assistive devices such as walkers or canes, however. As this disease can sap a person's energy or impact balance, some choose to use a mobility scooter or wheelchair to get around.
Multiple Sclerosis and Your Eyes
Now that you understand a bit more about multiple sclerosis, understanding the various eye issues MS can cause will be easier. As there are treatments available for visual issues caused by MS, it's imperative for you to be aware of potential issues and report them to your ophthalmologist right away if you notice symptoms.
Multiple Sclerosis and Optic Neuritis
Optic neuritis is a condition where the optic nerve that connect your eye to your brain becomes inflamed. This can cause blurry vision, a dimming of vision, or even a complete loss of vision. With proper treatment, most cases of optic neuritis are fully recovered within five weeks. Corticosteriods are most commonly used to combat the inflammation and relieve the symptoms. Be aware that over half of people with MS will get optic neuritis at least once, so it's crucial you note symptoms quickly and be examined as soon as possible if they manifest. Optic neuritis associated with MS typically presents as a monocular painful vision loss that occurs over hours to days and lasts a few weeks. Changes in visual acuity can range from mild to severe; 10% of patients are 20/20, 25% are 20/30-20/40, 29% are 20/50-20/190 and 36% are 20/200 or worse. Orbital pain occurs in 92% of patients and is usually worse with extraocular movement.
Patients will also present with diminished color vision (dyschromatopsia in 88%, best assessed by red desaturation), diminished contrast sensitivity, visual field loss (most commonly central scotoma) and a relative afferent pupillary defect (RAPD). Slit lamp examination will reveal optic disc swelling in one-third of patients.
Multiple Sclerosis and Diplopia
Commonly called double vision, diplopia can make everyday activities such as reading or enjoying television difficult. For some patients, it can also cause vertigo or nausea. For people who have MS, the diplopia is caused by the nerves responsible for eye movement being affected. Treatment with steroids is the go-to solution. If the condition persists, special glasses may be used to focus the patient's vision.
Multiple Sclerosis and Nystagmus
Nystagmus is a condition where the eyes make involuntary movement. People with MS may notice an annoying "jumping" of the eye while trying to focus on a task or read. It can affect one eye or both eyes. As with diplopia, this is caused by the nerves responsible for eye movement not working properly and steroids may be able to help. For some patients, Botox injections into the offending eye muscle can be tried. This is, however, an off-label use and is usually only considered if the condition is both persistent and very annoying to the patient.
Coping with Persistent Visual Changes Due to Multiple Sclerosis
There are many different coping mechanisms patients can make use of if their vision have been persistently or permanently affected by MS. Some solutions include:
- Special eye glasses that magnify objects. This is especially helpful for those whose eyesight has dimmed but is stable for now.
- Assistive devices such as text-to-speech software, talking cell phones or clocks that announce the time.
- Support groups for any emotional issues you may be struggling with while coming to terms with your persistent visual issues and your MS diagnosis overall.
- Occupational therapy to help with navigation can help avoid nasty falls and help retain independence.
- NHS Choices: Introduction to Multiple Sclerosis
- National MS Society: Living Well with Multiple Sclerosis
- ContactLenses.co.uk: Transient Smartphone Blindness misdiagnosis
- ContactLenses.co.uk: Eye Health Central
- The How, What, and Why of Multiple Sclerosis (Including New Treatments)
Author: John Dreyer Optometrist Bsc(Hons), MCOPTOM, DipCLP
Created: 19 Mar 2017, Last modified: 17 Jul 2019