Vision and eye problems are common among people with multiple sclerosis, also known as “MS”. They are often the first symptoms of MS, but can happen later in the course of the disease as well.
Some of the eye complications associated with MS include double vision and optic neuritis.
These two symptoms can occur acutely as part of a relapse. In most cases, symptoms get better over time, but there can still be lingering after effects.
The symptom of diplopia, also known as double vision, usually happens when the eyes are not aligned and don’t point at the same object at the same time. It could have numerous causes.
Misalignment of the eyes is caused by lesions of either the brainstem, which is the portion of the brain that connects to the spinal cord, or the cerebellum – a structure in the back of the brain just above the brainstem.
The doubling of the image may be up and down, side to side or a combination of the two. They could vary depending on the visual task, such as reading versus staring at something far away.
IV steroids can be tried for acute symptoms. If a person does not respond to steroid treatment, doctors might recommend plasmapheresis. This is when the liquid portion of the blood, or plasma, is taken out and most commonly replaced with albumin or other proteins.
Special eyeglasses containing prisms could be used to bring the images seen by one eye into alignment with those seen by the other eye when double vision has stabilized.
If prisms do not work well, strabismus surgery to realign the eyes with one another might be an option.
Many patients will continue to recover from an attack over six months or even a year to a year and a half, so corrective surgery and prisms shouldn’t be considered early on.
Persistent double vision might increase with fatigue and improve with rest.
Inflammation of the optic nerve caused optic neuritis. The optic nerve connects the eye to the brain. Symptoms include blurred vision, eye pain, impaired color vision, graying of vision and loss of peripheral vision.
Optic neuritis could arise in one eye at a time or in both eyes at the same time. It might occur only once in a person’s lifetime or reoccur many times.
Treatment with steroids could speed up recovery by reducing inflammation and dampening the activity of the immune system, but using steroids does not affect how well a person will see after an episode of optic neuritis. Low-contrast visual sharpness is impaired, which makes it difficult to see at dusk. This could result in difficulty driving.
For people who have ongoing difficulty in being able to see in low light, extra lighting at home and at work – such as computer screen filters, special glasses and magnifiers – might help to compensate.
After a patient has recovered from a bout of optic neuritis, heat or stress from Uhthoff’s phenomenon could cause temporary visual symptoms that will clear up when the stress is removed or the person cools off.
Do you have a question about double vision or optic neuritis? Click here to see ophthalmology and adult strabismus expert Dr. Sami for an exam!