Visual Disturbances

The most common visual issues experienced by people with MS are optic neuritis, double vision and eye movement problems. 

Optic neuritis is inflammation that damages the optic nerve, a bundle of nerve fibres that transmits visual information from your eye to your brain. The damage to this nerve causes blind spots or areas of poor vision, which can affect one eye or both. Colour vision can also be severely affected, making colours appear darker or washed out. For some people, optic neuritis can be painful, especially when moving your eyes. Optic neuritis can occur suddenly, is progressive and usually reaches its peak after about two weeks before symptoms start to improve. 

Double vision, also known as diplopia, is the experience of seeing double of a single subject. The subject may appear side-by-side, stacked together, or even as a tiled image. If you’re experiencing double vision, you may also have a loss of balance. 

Eye movement problems, also known as nystagmus, are involuntary movements of the eyes, from side-to-side, up and down, or in a rotary manner. This sometimes goes unnoticed by people with MS but can be seen by an observer. Nystagmus may contribute to dizziness, nausea and impaired balance. 

Optic neuritis, double vision and eye movement problems are all caused by damage to nerve fibres caused by MS. 

In optic neuritis, the immune system mistakenly targets the substance covering your optic nerve (myelin), resulting in inflammation and damage to the myelin. Normally, myelin helps electrical impulses travel quickly from the eye to the brain, where they’re converted into visual information. The inflammation caused by optic neuritis disrupts this process, affecting vision.

Double vision and eye movement problems occur in MS when the nerve pathways in the brain that control eye movements are damaged. Like optic neuritis, the messages are unable to travel from the brain to the eye, and vice versa, and result in uncoordinated eye movements.

If you feel eye pain, experience double or blurred vision, colours appear to have faded, or seem to have ‘blind spots’, talk to your neurologist, MS Nurse or GP. An eye assessment can determine how much inflammation is present and will inform your doctor whether treatment will speed up the recovery of your vision.

Visual disturbances can affect almost all aspects of daily life, including work, driving, social and leisure activities. You may find it is harder to do the things you normally do or may need assistance. 

There are a range of simple things you can implement into your routine to help you around home and/or at work. For example, if you’re experiencing double vision, you can patch one eye to block out the double image. Or, if you wear glasses, you can get these fitted with special prisms to realign the two images. 

Speak to your healthcare team who can help you develop a personal treatment and management plan. 

Treatments for visual disturbances depend on the type of issue you are experiencing. A discussion with your neurologist, MS Nurse or GP alongside a thorough assessment, is essential to determining the best treatment approach for your circumstance. In most cases, eyesight problems can be treated, or if associated with a relapse, they often will improve on their own. 

Optic neuritis is usually transient and associated with good recovery, which takes four to six weeks. For most people with MS, eyesight can return to normal without treatment. Depending on severity, optic neuritis is sometimes treated with corticosteroids, which aim to reduce the inflammation and speed up recovery. 

If you are experiencing double vision (diplopia) as part of a relapse, often it will improve on its own. Corticosteroid treatment can help to speed up the recovery process. For long lasting double vision problems, your healthcare team will be able to discuss other treatment options with you, such as botulinum toxin or surgery, which adjust the muscles that control vision to restore the symmetry of your eye position. 

Nystagmus can be a difficult symptom to treat, but there are options available. Your healthcare team will be able to discuss options with you, including drug therapies, depending on your individual circumstance.