MS Eye Complications Involving Both Eyes: Optic Neuritis, Nystagmus, Diplopia

Understanding Eye Complications That Can Affect Both Eyes With Multiple Sclerosis

Multiple sclerosis (MS) is an autoimmune disease that affects the central nervous system. It often leads to issues with vision, with a variety of eye complications that can involve both eyes. Optic neuritis, nystagmus, and diplopia are some of the most common MS-related eye conditions that impact both eyes and can significantly affect a person's vision and quality of life.

Optic Neuritis

Optic neuritis is inflammation of the optic nerve, which transmits visual information from the eyes to the brain. It causes eye pain and vision loss, usually in one eye initially but often progresses to affect both eyes over time. Up to 50% of MS patients experience optic neuritis at some point.

Symptoms of optic neuritis include:

• Decreased vision or blurriness, often worse when using the affected eye
• Color desaturation - colors appearing washed out or faded
• Pain with eye movement
• Diminished contrast sensitivity and visual acuity
• Difficulty seeing in low light
• Blind spots or dark areas in central vision

Optic neuritis often resolves on its own within 8 weeks, but corticosteroid treatment can speed recovery. However, some permanent vision loss may occur, and recurrence in the same or fellow eye is common without treatment. Optic neuritis in both eyes simultaneously is less typical but can happen.

Nystagmus

Nystagmus causes involuntary, rhythmic eye movements or shaking. The eyes move slowly in one direction then jerk rapidly back in the other direction. It is estimated around 1 in 4 people with MS experience nystagmus.

Nystagmus can affect one or both eyes. When affecting both eyes, the involuntary movements may happen in the same or opposite directions. Nystagmus often worsens when the eyes look to the side. Symptoms include:

• Decreased visual acuity
• Difficulty seeing objects clearly
• Blurring or bouncing vision
• Dizziness or vertigo
• Nausea

Nystagmus in MS results from damage to areas of the brain and brainstem that control eye movements and hold the eyes in place. Treatments aim to limit the eye movements with prism lenses, convergence exercises, medications, or surgery in severe cases.

Diplopia

Diplopia, or double vision, occurs when the eyes are misaligned and unable to properly focus on the same object. As a result, the brain receives two different images from each eye. Diplopia is one of the most common vision issues with MS, impacting around 1 in 3 people.

Causes include:

• Weakness or imbalance of the muscles controlling eye movement due to MS damage in the brainstem.
• Internuclear ophthalmoplegia - damage to the nerve fibers coordinating eye movement between the eyes and brain.

Symptoms include seeing two overlapping images, eyestrain, headaches, and difficulty reading or performing tasks requiring precise vision. Diplopia can come and go but often worsens with fatigue. Treatments like eye patches, prisms, or vision therapy help realign the eyes and restore single vision.

Diagnosing Eye Issues Related to MS

Since eye complications are so common with MS, frequent ophthalmologic exams are recommended to monitor for any vision changes. Diagnostic tests may include:

Visual acuity

Measures sharpness of vision using a Snellen eye chart. Decreased visual acuity can indicate optic neuritis, nystagmus, or neurological damage from MS.

Eye movement testing

Observing eye movements helps diagnose abnormalities like nystagmus. Following a moving object with just the eyes can reveal deficits in eye muscle coordination.

Pupillary light response

Assessing pupil reaction to light identifies optic neuritis or nerve damage affecting the eyes.

Ophthalmoscopy

Examining the back of the eye (retina and optic nerve) with an ophthalmoscope that detects swelling, abnormalities, or nerve damage.

Visual field testing

Measures peripheral vision and ability to detect objects in different visual field zones. Deficits may indicate optic neuritis.

Contrast sensitivity

Assesses ability to distinguish between progressively fading shades. Reduced contrast sensitivity is an early sign of optic neuritis.

Eye imaging

Retinal imaging or tests like optical coherence tomography (OCT) provide detailed structural views of eye tissues to identify areas of damage or inflammation.

Treating MS-Related Eye Conditions

While permanent vision loss can occur with some MS eye complications, treatment is aimed at managing symptoms and maximizing vision capabilities. Approaches may include:

Corticosteroid therapy

Steroids like intravenous methylprednisolone speed recovery from acute optic neuritis attacks and other MS relapses affecting vision.

Disease-modifying therapy

MS medications like interferon betas, fingolimod, or natalizumab help reduce MS relapses and progression of disability.

Prisms

Prisms placed on eyeglass lenses reposition images to resolve diplopia by redirecting light before it enters the eyes.

Eye patches

Covering one eye eliminates the second image that creates double vision. Can alternate between eyes.

Vision therapy

Exercises supervised by an optometrist train eye muscles and visual processing to improve control of eye movements and binocular vision.

Medications

Drugs like gabapentin or baclofen help reduce abnormal eye movements from nystagmus. Botulinum toxin injections can also relax spasming eye muscles.

Surgery

Surgeries to reposition extraocular eye muscles or redirect them with sutures can improve alignment and treat diplopia in severe, persistent cases.

Coping With Vision Changes From MS Eye Complications

MS-related vision problems can significantly impact daily function, but making adjustments can help cope with visual limitations:

Use vision aids

Magnifying lenses, large print text, audiobooks, screen readers, and other visual aids boost accessibility when vision declines.

Modify contrast

Improving lighting, using bold text, reducing glare, and adding color contrast between objects compensates for reduced contrast sensitivity.

Adapt home and work areas

Improve lighting, declutter walkways, add hand/guard rails, use high-contrast tape for stairs, and make other modifications for low vision safety.

Take regular breaks

Rest eyes frequently when reading or doing visual tasks. Eye fatigue can exacerbate vision problems.

Ask for help when needed

Have someone assist with tasks like reviewing medications, navigating unfamiliar places, reading small text, etc.

Join a support group

Connecting with others experiencing MS vision changes provides coping strategies and emotional support.

The Outlook for MS-Related Eye Conditions

Eye symptoms are often some of the earliest manifestations of MS. Vision loss from optic neuritis may stabilize or improve slightly over time. But conditions like nystagmus and diplopia tend to persist and progress with the overall disease course since they stem from neurological damage.

Treating acute flare-ups and actively managing MS with disease-modifying therapies can help limit further vision loss. Close monitoring by both a neurologist and ophthalmologist allows for early intervention for inflammation or changes in vision. Occupational therapy, vision rehabilitation, and adaptive tools also enable MS patients to adjust to vision changes and maintain independence.

While MS eye complications can be challenging, a proactive treatment approach and support system helps many patients successfully cope with vision limitations from the disease.

Disclaimer: This article is for informational purposes only and does not constitute medical advice. Always consult with a healthcare professional before starting any new treatment regimen.