What are the eye symptoms of Multiple Sclerosis (MS), including blurry vision, and is dizziness a symptom of MS?

Eye Symptoms of Multiple Sclerosis (MS)

Optic neuritis is the most common ocular manifestation of MS, typically presenting as painful visual loss that can be unilateral or bilateral, and is often the initial clinical manifestation of the disease. 1, 2

Common Visual Symptoms in MS

• Optic Neuritis: Characterized by visual impairment, scotoma (blind spot), red-green color desaturation, and pain with ocular movement 1
• Blurry Vision: A frequent symptom that can result from optic neuritis, nystagmus, or internuclear ophthalmoplegia 2, 3
• Diplopia (double vision): Commonly caused by brainstem lesions affecting ocular motor pathways 3, 4
• Oscillopsia: Illusory visual motion or bouncing of images due to nystagmus or other ocular motor disorders 5, 4
• Visual Field Defects: Including homonymous hemianopia that can resolve after treatment 6
• Color Vision Abnormalities: Significant reduction in color perception even with near-normal visual acuity 3, 6
• Contrast Sensitivity Reduction: Can occur despite recovery of central visual acuity 3

Is Dizziness a Symptom of MS?

• Yes, dizziness is a common symptom of MS, particularly when lesions affect the vestibulocerebellum, brainstem, thalamus, or basal ganglia 2
• Dizziness may be associated with nystagmus and balance difficulties, which are reported as frequent systemic manifestations 4

Ocular Motor Disorders in MS

• Internuclear Ophthalmoplegia (INO): Failure of ipsilateral eye adduction with contralateral eye abduction nystagmus, caused by lesions in the medial longitudinal fasciculus 2, 6
• Nystagmus: Various types can occur, including downbeat nystagmus in primary position 6
• Abducens Nerve Palsy: Affecting lateral eye movement 6
• Skew Deviation: Vertical misalignment of the eyes 6
• One-and-a-Half Syndrome: Combination of gaze palsy and INO 6

Diagnostic Imaging for MS-Related Visual Symptoms

• MRI of both orbits and head with contrast is the primary imaging study for suspected optic neuritis 1
• MRI serves two purposes:
  1. Evaluating for abnormal enhancement and signal changes within the optic nerve
  2. Evaluating the brain for associated intracranial demyelinating lesions 1
• Typical acute optic nerve lesions show T2 hyperintensity, optic nerve swelling, and contrast enhancement 1

Clinical Course and Prognosis

• Most patients with demyelinating optic neuritis have excellent prognosis for recovery of central visual acuity 3
• However, after second attacks of retrobulbar optic neuritis, visual recovery may be less complete 6
• Chronic lesions exhibit atrophy and T2 hyperintensity on MRI 1
• Visual symptoms may worsen with heat exposure (Uhthoff phenomenon) 4

Other Important Considerations

• Optic nerve involvement is now considered an additional criterion to demonstrate dissemination in space for MS diagnosis 1
• The presence of even one clinically silent T2 hyperintense brain lesion in patients with optic neuritis is highly associated with MS diagnosis 1
• Approximately 70% of MS patients report eye complaints as their initial symptom 4
• Visual symptoms that persist or worsen independently of head pain warrant evaluation for true optic pathway disease 7

Treatment Implications

• Acute relapses, including optic neuritis, are typically treated with high-dose corticosteroids 2
• Disease-modifying medications are used for relapse prevention 2
• Some treatments may have adverse effects on vision, including central serous retinopathy with corticosteroid therapy and macular edema with fingolimod 2
• Approximately one-third of MS patients with visual symptoms may benefit from orthoptic therapy, prisms for diplopia, or visual field manipulation 4