What are some of the Eye Problems seen in patients with Multiple Sclerosis (MS)?

Optic neuritis (inflammation of the optic nerve) is a very common and frequently an early presentation of Multiple sclerosis. About 25% of MS patients first present with Optic neuritis. Typically there is sudden blurriness or loss of vision in the affected eye with pain or discomfort exaggerated on eye movements. The vision loss progresses in the first week, and then gradually improves in the next few weeks in most patients. The loss of vision also may get temporarily exaggerated with exposure to heat resulting in an increased core body temperature (Uhthoff’s phenomenon). Besides losing central vision, they also have reduced color vision, an abnormal pupil reaction, visual field defect and an examination of the optic nerve may reveal a swollen optic nerve. In some cases, the swelling is right behind the optic nerve (retrobulbar optic neuritis) and thus not visible on direct examination. An MRI of the Brain usually demonstrates white matter lesions seen in typical locations (demyelinating plaques).

Sudden onset of double vision is another finding in MS. In this condition the patient usually complains of double vision with both eyes open and the separation of the images is usually horizontal. This results from an inflammation located in the brain stem (demyelination in the midbrain resulting in Internuclear Ophthalmoplegia (INO)). There are some who may complain of rapid eye movements (nystagmus) where objects appear to be in a constant state of rapid motion. Other eye findings include an inflammation in the eye called pars planitis and vasculitis in the retina.

The risk of developing MS is increased in a patient with typical optic neuritis if associated with:

1. A brain MRI showing 1 or more white matter lesions
2. A family history of MS
3. Previous episodes of neurological symptoms often seen in MS (numbness or tingling of hands/feet, dizziness, balance problems, bowel and bladder control problems, excessive fatigue)
4. Recurrent episodes of typical optic neuritis.

Please Note: All patients with Optic neuritis do NOT have MS. Once symptoms & signs are typical (as above, seen in young adults, women greater than men) and have positive accompanying risk factors including MRI and Spinal fluid test findings the risk of developing MS is higher.

Author

Dr. Swaraj Bose Neuro-Ophthalmologist & Orbital Surgeon