Multiple sclerosis and vision
If you’ve recently been diagnosed with multiple sclerosis (MS), you’re probably wondering how this disease will affect your body. Many people know the physical effects, such as weakness or numbness in your limbs, tremor, unsteady gait, and tingling or stinging sensations in parts of the body. What you may not know is that MS can also affect your vision.
Individuals with MS will likely experience double vision or blurry vision at some point. You may also partially or entirely lose your sight. This often happens to one eye at a time. People who experience partial or full vision problems are more likely to end up with some level of permanent vision loss.
If you have MS, vision changes can be a big adjustment. It’s important to know that you have options. Occupational and physical therapists can help you learn to live your daily life in a healthy, productive manner.
Types of vision disturbances
For individuals with MS, vision problems may come and go. They may affect just one eye or both. The problems may grow worse and then disappear, or they may stick around. Understanding what types of visual disturbances you may experience can help you prepare for living with them if they become permanent.
Common visual disturbances caused by MS include:
Optic neuritis causes blurry or hazy vision in one eye. This effect might be described as a smudge in your field of vision. You may also experience mild pain or discomfort, especially when moving your eye. The greatest visual disturbance will likely be in the center of your field of vision.
Optic neuritis develops when MS begins to break down the protective coating surrounding your optic nerve. This process is called demyelination. As MS grows worse, demyelination will become more widespread and chronic. That often means the symptoms will grow worse and your body may not return entirely to normal once the symptoms disappear.
According to the Multiple Sclerosis Trust, 70 percent of people with MS will experience optic neuritis at least once during the course of the disease. For some people, optic neuritis may even be their first symptom of MS.
The symptoms of pain and blurred vision may get worse for up to two weeks, and then begin to improve.
Most people have normal vision within two to six months of an acute episode of optic neuritis. African-Americans usually experience more severe vision loss, with one study showing only 61 percent vision recovery after one year. By comparison, 92 percent of Caucasians recovered their vision. A different study found that the more severe the attack, the poorer the outcome.
Diplopia (double vision)
In normally functioning eyes, each eye will transmit the same information to the brain for it to interpret and develop into an image. Diplopia, or double vision, occurs when the eyes send two images to your brain. This confuses your brain and can cause you to see double.
Diplopia is common once MS begins to affect the brainstem. The brainstem helps coordinate eye movement, so any damage to it may result in mixed signals to the eyes.
Diplopia can resolve completely and spontaneously, though progressive MS can lead to persistent double vision.
Nystagmus is an involuntary movement of the eyes. The movement is often rhythmic and results in a jerking or jumping sensation in the eye. You may experience dizziness and nausea as a result of these uncontrolled movements. Oscillopsia, a feeling that the world is swaying from side to side or up and down, is also common in people with MS.
This type of visual disturbance is often caused by an MS attack affecting the inner ear or on the cerebellum, the brain’s coordination center. Some people only experience it when looking in one direction. The symptoms may get worse with certain activities.
Nystagmus typically occurs as a chronic symptom of MS or during a relapse. Treatment can help repair your vision and sense of balance.
As MS grows more severe, so will the symptoms. This includes your vision. People with MS may experience blindness, whether partial or full. Advanced demyelination can destroy your optic nerve or other parts of your body responsible for vision. This can permanently affect eyesight.
Different treatment options are available for each type of visual disturbance. What’s best for you depends on your symptoms, the severity of your disease, and your overall physical health.
Commonly used treatments include:
- Eye patch: Wearing a covering over one eye may help you experience less nausea and dizziness, especially if you have double vision.
- Steroid injection: The injection may not improve your long-term vision, but it can help some people speed up recovery from a disturbance. It works by delaying the development of a second demyelinating occurrence. You are typically given a course of steroids over a 1- to 5-day period. Intravenous methylprednisolone (IVMP) is given over three days. Risks and side effects can include stomach irritation, increased heart rate, mood changes, and insomnia.
- Other medications: Your doctor may try to help resolve some of the side effects of the visual disturbance until it ends. For example, they may prescribe medication such as Clonazepam (Klonopin) to help ease the swaying or jumping sensation caused by nystagmus.
A 2016 study on the relationship between a common antihistamine and MS has found evidence that clemastine fumarate may actually reverse optic damage in people with MS. This may be possible if the antihistamine repairs the protective coating in patients with chronic demyelination. While this needs to be studied further, it could offer hope to those who have already experienced optic nerve damage.
Preventing vision disturbances
While vision disturbances in MS patients may be unavoidable, there are steps you can take to help prevent or reduce the likelihood of their occurrence.
When possible, resting your eyes throughout the day can help prevent an oncoming flare-up or lessen its intensity. Early diagnosis and treatment can reduce the severity of visual disturbances and can prevent long-term damage. Doctors can also prescribe glasses that help contain the prisms that shift the eye.
Those who already have visual impairment before their MS diagnosis will be more susceptible to greater damage, and the damage could have a greater impact. As a person’s MS progresses, they’ll also be more susceptible to vision disturbances.
Coping with vision changes
Knowing your triggers can help you prevent or reduce the frequency of your relapses. A trigger is anything that brings on your symptoms or makes them worse. For example, people in warm environments may have a more difficult time with their MS symptoms.
A slightly increased core body temperature impairs the ability of a demyelinated nerve to conduct electrical impulses, increasing MS symptoms and blurring vision. People with MS can use cooling vests or neck wraps to maintain a body temperature during outdoor or physical activity. They can also wear lightweight clothing and consume icy drinks or ice pops.
Other triggers include:
- cold, which can increase spasticity
- fatigue and lack of sleep
Work with your doctor to identify possible triggers so you can better manage your symptoms.
In addition to trying to prevent visual problems, you should also prepare yourself to live with them. Visual disturbances can have a significant impact on your life, both in terms of day-to-day living and your emotional well-being.
Talk with your doctor
Finding an understanding, uplifting support group among your friends, family members, and larger community can help you prepare for and accept the visual changes that may become more permanent. Your doctor may also be able to recommend a community organization that is designed to help people with vision problems learn new ways to live their lives. Talk with your doctor, therapist, or your hospital’s community center for suggestions.