Vision problems are often among the first symptoms that appear in people with multiple sclerosis (MS). Since they’re easy to notice and affect day-to-day life, visual symptoms might prompt people with MS to visit a healthcare professional and determine the cause.

“The symptom that made me pay enough attention to go to the doctor was my vision change,” one MyMSTeam member wrote. Visual problems can also occur in people who have lived with MS for longer periods of time.

Seeking help for vision problems is important because they can affect your balance and risk your safety. They can also have an impact on your independence, productivity, and ability to travel.

What Vision Problems Can MS Cause?

As with other symptoms of multiple sclerosis, everyone experiences vision problems a little differently. Here’s how members of MyMSTeam have described vision and eye problems:

• “My vision goes really dark to really bright, which gives me a headache.”
• “It’s like living in a black-and-white TV show. My eye also twitches like crazy.”
• “I feel like I have two eyes that aren’t working together. It makes sight look like it’s not real — like a cartoon or drawing.”

Types of Vision Problems in MS

MS can affect vision in several ways. Vision problems associated with MS may include diplopia (double vision), nystagmus (uncontrolled eye movements), eye floaters, and optic neuritis.

Double Vision

Diplopia can be an early symptom of MS. In people with MS, diplopia is related to damage to the nerves that control eye movement. This causes a misalignment in the eyes. Double vision is sometimes temporary but can be persistent.

“The symptom that made me pay enough attention to go to the doctor was my vision change.”

— A MyMSTeam member

Nystagmus

Nystagmus is a vision problem that causes the eyes to move from side to side or up and down in a repetitive, uncontrolled manner. It’s sometimes called “dancing eyes.” Nystagmus can also prevent a person from holding a steady gaze. This can lead to or worsen dizziness and nausea, which can contribute to balance issues and falls. Nystagmus may be persistent, or it may come and go.

MS can damage the nerves in the cerebellum or brainstem of the central nervous system and cause nystagmus. The cerebellum and brainstem are both regions of the brain responsible for muscle movement, vision, and balance. Nystagmus may also be caused by optic nerve damage, which disrupts the interpretation of visual information.

Floaters

Floaters are relatively common among people with MS and vision problems. These spots in your vision disappear or shift if you try to look at them. You may have one or many of them. Floaters often appear as small dots but can also show up as rings, lines, or other shapes.

Floaters have a number of causes, including normal aging and uveitis (inflammation of a layer lining the wall of the eye). In the most common form of uveitis, inflammation primarily affects the peripheral retina. Floaters aren’t harmful, but they can cause persistent vision issues if they make it difficult to see fully.

Optic Neuritis

Optic neuritis is among the common eye problems caused by MS, and it’s often one of the first symptoms of the condition. “People experience blurred vision in one or both eyes and often also experience pain with eye movements,” explained Dr. Jacqueline Nicholas, a neurologist and MS specialist at the OhioHealth Multiple Sclerosis Clinic in Columbus, Ohio.

MS can also cause a scotoma — a blurry, dim, or blind spot. A scotoma may occur in the center of the visual field without changing peripheral vision. Optic neuritis may also affect color vision and make colors appear gray.

“It’s like living in a black-and-white TV show.”

— A MyMSTeam member

Optic neuritis is linked to neuromyelitis optica, a rare condition that can cause blindness and paralysis. Treatments to prevent future attacks of neuromyelitis optica are different from MS treatments to prevent relapses, so an accurate diagnosis of the vision problem is important.

Optic neuritis in MS is commonly due to optic nerve inflammation and demyelination. “It’s caused by an immune attack of someone’s own white blood cells attacking the myelin coating on the optic nerve,” Dr. Nicholas said.

Who Does Optic Neuritis Affect?

Vision loss is the first MS symptom for 1 in 4 people with MS, according to Multiple Sclerosis Trust. As many as 7 out of 10 people with MS will experience optic neuritis at some point, according to the nonprofit.

Optic neuritis doesn’t affect only people with MS. Between 1 and 5 people in 1,000 in the general population experience optic neuritis, per the Multiple Sclerosis Trust. Much like MS, optic neuritis tends to affect more women than men and develops between ages 20 and 40.

This vision problem can occur regardless of a person’s type of MS. “We see optic neuritis in relapsing MS because it typically comes on in the form of a relapse,” Dr. Nicholas said. People who have secondary progressive MS can also develop optic neuritis.

How Are Double Vision and Blurred Vision in MS Treated?

The prognosis for recovery is promising for many MS-related vision problems. “For many people with optic neuritis, it often improves with time, although improvement may not be complete,” Dr. Nicholas explained. “The good news is that there are options to help individuals with decreased vision often offered through low-vision clinics.”

Treatment options for vision problems may include steroids during onset, plasmapheresis, and specialized lenses.

Treating Optic Neuritis

High doses of steroids (also called corticosteroids), such as methylprednisolone (Solu-Medrol), are often the go-to treatment for an episode of optic neuritis in people with MS. Steroids are commonly delivered intravenously (through a vein). Dr. Nicholas said the dosage is “usually a gram of that once a day for anywhere between three to five days.” High-dose oral steroids can also be used to treat optic neuritis, but only after initial treatment with IV forms.

Treating Eye Floaters

Floaters are usually considered harmless and typically aren’t treated by doctors. In extreme cases that significantly affect vision, some doctors will recommend surgery to try to remove them.

To help relieve problems from floaters, you can take steps such as wearing sunglasses outdoors and protective eyewear in bright light. Resting your eyes frequently can also reduce the negative effects of floaters and help you see properly.

Treating Nystagmus

Nystagmus is more complicated than other MS-related vision problems. There are fewer treatment options to address involuntary eye movements. Sometimes, eyeglasses or contact lenses help slow the uncontrolled movements of the eyes and improve vision. Drugs like gabapentin (Neurontin) may be used to reduce eye movement or twitching and spasms.

In rare instances, surgery is used to address nystagmus. However, surgery doesn’t directly address the symptoms of nystagmus.

Treating Diplopia

Double vision that occurs due to an MS relapse often resolves itself partially or fully. Treatment with steroids can hasten recovery. Some people wear a patch over one eye to help with diplopia.

A Fresnel prism is a special lens that attaches to glasses and adjusts the way light enters a person's eyes. In some instances, a Fresnel prism can help realign the two images in double vision by altering the way visual information enters the eye.

Double vision sometimes persists for a long time. In these cases, Botulinum toxin (Botox) or surgery may be used to help bring the eyes back into proper alignment.

By joining MyMSTeam, the social network and online support group for those living with multiple sclerosis, you gain a support group of more than 218,000 members. Vision problems are one of the most discussed topics — more than 17,000 MyMSTeam members experience vision issues.

Have you experienced vision problems related to MS? Do you get eye floaters or blurred or double vision? Share your experiences in the comments below, or start a conversation by posting on your Activities page.