How MS Affects Your Vision
Multiple sclerosis (MS) can damage the nerves in any part of the brain or spinal cord. This can cause symptoms in many parts of your body, including your eyes. Although each person’s symptoms are unique, nearly everyone with MS will experience some vision problems, such as blurriness, double vision, or vision loss. Like other symptoms of MS, these visual problems usually come and go. Only rarely do they result in permanent blindness.
Why MS Affects Vision
Doctors initially diagnose about half of all people with MS because of a vision problem. A flare-up of the disease may have damaged the optic nerve – the nerve that connects the eye to the brain, the nerves from the brainstem to the eye muscles, or both.
In MS, the body attacks the nerve fibers and the myelin that covers or insulates them. This damage to the nerves in the spinal cord and brain disrupts communication between the brain and other parts of the body. As a result, you can have symptoms such as muscle weakness, balance problems, numbness or tingling in the extremities, speech problems, and dizziness. When MS damages the optic nerve or the pathways that control eye movements, vision problems can result.
Two-thirds of the brain is involved in processing the images it receives through your eyes. However, MS usually affects areas of the brain that are not involved in visual processing. It’s more likely that MS will affect the optic nerve or the pathways that send signals from the brainstem to the eye muscles. These nerve pathways allow the eyes to move in unison.
Vision Problems Resulting From MS
Damage to the optic nerve can lead to a condition called optic neuritis. This inflammation of the optic nerve or damage to the myelin that covers the optic nerve can be painful. It can also cause a number of eye problems, such as blurred vision, loss of normal color vision, depth perception problems, and seeing a dark spot in the center of your visual field. In some cases, blindness may occur, typically in only one eye at a time.
Most people with optic neuritis regain normal sight. In some cases, vision quality may be reduced, with less color or depth perception. Several bouts of optic neuritis can decrease vision quality over time. That's why it's important to notify your doctor promptly if you suspect your MS has relapsed.
Damage to the pathways that control eye movements can cause the eye muscles to move in an uncoordinated way. If the eyes do not work together properly and move in unison, it can affect your vision. Damage to these pathways from the brainstem to the eye muscles can also lead to nystagmus. Nystagmus is involuntary or uncontrolled movements of one or both eyes. This condition impairs vision in a number of ways, including horizontal or vertical "wiggling." It can also result in dizziness or a loss of balance.
In other cases, you might notice that one eye muscle is weaker than the other. If you have weakness in one or both eye muscles, you can have double vision – or diplopia – because your eyes are not aligning properly.
Involuntary eye movements can be subtle and hard to identify, but in more extreme cases, they can be very noticeable. You may experience visual confusion, reading fatigue, and loss of depth perception.
How Vision Problems Are Treated
Optic neuritis and other vision problems with MS almost always resolve on their own and require no treatment. There is a healing process that takes place after MS damages the myelin that covers nerve fibers. Although your vision will improve in most cases, you might have a relapse or a worsening of your vision problems.
Your doctor may prescribe IV and oral corticosteroids to help treat certain vision problems related to MS. If you have double vision, an ophthalmologist might prescribe prisms, an eye patch, or lenses to improve visual acuity.
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