Symtom Awareness
Visual Problems
Visual problems are one of the more common symptoms of MS and are sometimes the first signs of the disease. Visual problems may include: optic neuritis (decreased vision), diplopia (double vision), nystagmus (uncontrolled eye movements), cecocentral scotoma (blind spot in center of vision), and homonymous hemianopsia (vision lost on right or left visual fields).
Causes of Vision Loss
Many functions are involved in seeing an object. Two major components of effective vision can be affected by MS. These two components are: (1) the ability to correctly image what is seen and (2) the proper coordination of the muscles that surround the eye and control its movements. Either or both of these can be affected by MS. In addition to an exacerbation, visual problems in MS can be brought on by fatigue, an increase in temperature, stress, and infection. Managing these symptoms may help to improve the visual problems one is experiencing.
Causes of Vision Loss
Optic neuritis is one of the most common visual problems for individuals with MS. Optic neuritis occurs when inflammation and demyelination are present along the optic nerve (the nerve which connects the brain to the eye). Frequently, optic neuritis is the first symptom of MS. Being diagnosed with optic neuritis, however, may suggest MS, but does not mean that a person has or will develop MS. Symptoms of optic neuritis are the acute onset of any of the following:
- Decreased vision
- Blurred vision
- Graying of vision
- Blindness in one eye (usually temporary)
Rarely are both eyes affected simultaneously with optic neuritis. Pain with eye movement may precede visual loss. Loss of vision tends to worsen over the course of a few days before getting better. Almost 55 percent of people with MS will have an episode of optic neuritis (according to Web MD). Many of the visual disorders in MS stem from optic neuritis, such as colors appearing washed out (especially when the light is dim), and problems with night vision. Treatment of optic neuritis usually involves steroids.
Types of Visual Changes
Diplopia, also known as "double vision," occurs when the muscles that control a particular eye movement are weakened and not coordinated. Although annoying, double vision usually resolves on its own without medical treatment. When diplopia comes on suddenly, it could indicate an acute attack.
Nystagmus is the uncontrolled side-to-side (horizontal) or up-and-down (vertical) movements of the eye. It can be asymptomatic (causing no visual problems) or severe enough to disturb vision. Objects may appear to jump or move unpredictably as the two eyes no longer coordinate well with each other. Nystagmus can be more of nuisance than a major problem and is usually temporary.
Visual symptoms may also include temporary blindness, which can occur in just one eye during the time of an acute exacerbation of MS. Cecocentral scotoma is a symptom where a blind spot appears in the center of vision. Homonymous hemianopsia occurs less often, and is experienced as a decrease in vision on the right or left visual fields of both eyes simultaneously.
Treatment of Visual Disorders
A few options are available for treating a visual disorder. One's doctor might decide not to treat this type of disorder and wait to see if the visual symptoms go away on their own. On other occasions, steroid treatment may be used to reduce the inflammation and accelerate the recovery process.
Corticosteroids, such as prednisone and methylprednisone, are similar to the natural hormones produced in the body. These "natural" steroids help control many necessary functions of the body, such as:
- Immune system function
- Blood sugar levels
- Level of salts (electrolytes) in the blood
- The body' water balance
Steroids may be administered two ways. A high dose of methylprednisone may be given through intravenous injection (IV) daily for three to five days during an attack. Prednisone or methylprednisone in a pill form may also be administered orally for several days after IV treatment, or they may be taken alone without an earlier IV treatment. While corticosteriods may shorten MS attacks and help one to recover more quickly, no convincing evidence has been shown that corticosteriods can affect the long-term course of MS.
An eye patch can be used in treating diplopia (double vision), but the physician may advise the patient to reserve use until absolutely necessary, such as when driving or reading. Given time, the brain will often adjust and perceive images correctly. An ophthalmologist may offer other treatments as well, such as the use of yellow lenses to tone down light for those experiencing sensitivity to light.
In general, those who suffer from visual problems should consult their physician and discuss how to best treat their symptoms. Though they can be annoying, visual changes can often be managed, and these symptoms are usually temporary.
