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Your eyes play an important role in helping you understand the world around you. The optic nerve (eyes) sends visual information to the brain, which the brain processes into what you see.

MS can damage the nerve pathways in the brain and the optic nerve, which can cause temporary or ongoing visual changes or loss. It rarely results in total blindness.

With support and advice from your healthcare team, you can manage this symptom and live better with MS.

MS vision impairment

Optic neuritis is a condition that causes temporary pain, vision loss and visual disturbances. It is a condition in itself but it is often associated with MS. It’s caused by inflammation or damage to myelin – the protective coating around nerve cells. It affects the optic nerve, which transmits images from your eyes to your brain. Optic neuritis can cause:

  • vision loss
  • flashing or flickering lights with eye movement
  • blurriness in one eye
  • partial or complete loss of colour vision
  • pain when the eye moves or a dull ache behind the eye
  • reduced peripheral vision (indirect or side vision).

Optic neuritis is common in people with MS. It can occur or suddenly get progressively worse. It is often temporary and associated with a good recovery if treated early. The most common treatment is steroids, which are used to reduce inflammation. Symptoms in the eye can occur from other causes, such as migraine, so it’s important to investigate.

Our eyes work like two cameras that should take and send the same photo or visual message to the brain. Double vision – or diplopia – is when a single object appears as two. Diplopia can happen in MS when there’s damage to the nerve pathways that control vision. It causes visual messages between the eyes and brain to become confused, uncoordinated and false, giving you a double image or even affecting your balance.

Double vision may occur as part of an MS relapse and it can completely resolve on its own or with steroids used to treat the relapse.

Nystagmus is a condition that causes rapid, uncontrollable movement of one or both eyes. It can include a range of eye movements that are:

  • up-and-down (vertical nystagmus)
  • circular (rotary/torsional nystagmus)
  • side-to-side (horizontal nystagmus).

Nystagmus is usually caused by the part of the brain that regulates eye position and movement or less commonly by the inner ear. MS can damage the protective nerves that regulate this eye movement, causing the person to experience nystagmus.

If symptoms persist, it can make you feel dizzy, nauseous or lose your balance.

What to do if you experience vision issues

If you’ve noticed eye pain or changes to your vision – such as faded colours, double or blurred vision, or blind spots – talk to your GP or MS nurse as soon as possible. They should be able to help you or will refer you to the right specialist.

It’s likely they’ll do an eye assessment to determine if there’s any inflammation and the best course of treatment to assist with vision issues.

How to treat vision impairment symptoms

Treatments for vision impairments depend on what eye condition you’re experiencing.

Treatment for optic neuritis

There are several ways optic neuritis can be treated. If it is mild it may be that it goes away on its own in four to six weeks without treatment.

The most common way to treat optic neuritis is using strong anti-inflammatory medications called steroids. This may be in an infusion or as tablets.

Treatment for double vision

To reduce the impact of double vision, you can use a patch over one eye to block out one of the images sent to your brain. You can also place a temporary stick-on Fresnel prism lens on your glasses to realign the two images.

If you experience double vision as part of a relapse, it often recovers either partially or fully on its own. Steroid treatments are often used to speed up this recovery process.

For long-lasting double vision, your doctor may discuss other medical options, such as botulinum toxin or surgery, which aims to restore symmetry in your eye position.

Treatment for nystagmus

Nystagmus can be a difficult symptom to treat. Wearing contact lenses or eyeglasses to improve your vision may help slow down eye movement, however it won’t fully correct nystagmus.

An eye care professional can help you use null point training, so your eyes focus in the clearest direction. They may also suggest a magnifier to make it easier to read or suggest changes to your posture and environment, such as having good lighting and bringing reading material closer.

Your doctor may prescribe you medications, such as gabapentin or memantine, to reduce eye twitching. If nystagmus causes you to hold your head in an unusual position to improve your vision, neck and shoulder problems may arise. Your doctor may recommend a physiotherapist to help with the effect of this.

This page has been reviewed and approved by Executive Manager Client Engagement and Wellbeing Jodi Haartsen. Jodi is a registered MS Nurse who has helped thousands of patients over her 20 years’ experience at Eastern Health MS service in Australia, in several roles including nurse educator, research nurse and nurse practitioner. Jodi is the 2022 winner of the global MS Brain Health Leader Award in the Independent Healthcare Professionals category.

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