Vision changes in multiple sclerosis

Visual impairment in multiple sclerosis

Multiple sclerosis is a progressive disease in which the immune system mistakenly attacks healthy nerve cells. This damages the protective covering of these cells, called the myelin sheath.

.
Damage to these cells can cause “scarring” in the brain, leading to a range of symptoms. Although multiple sclerosis affects people differently, doctors note that vision problems are often the first symptoms of the disease. When MS affects the nerves of the eye, it results in inflammation called optic neuritis
. A person with optic neuritis may notice various vision problems, usually only on one side. These problems can appear suddenly or gradually and usually disappear over time.

Multiple sclerosis - vision loss

Often people with MS experience vision loss. Vision problems are usually observed on one side. A person experiencing these symptoms should consult a doctor immediately. Complete loss of vision is possible, but is not as common as other symptoms such as:

blurred vision;
loss of color;
pain when moving the eyes;
partial or complete blindness in one eye that worsens during an attack;
dull pain behind the eyes.

Nystagmus

People with MS may experience uncontrollable eye movements called nystagmus

. Nystagmus does not always occur in the same way, but often causes one or both eyes to move. A person may lose control of how the eye moves in a certain direction. The patient may also feel as if things are moving. The severity of nystagmus can vary. Some people may experience mild symptoms, while others experience eye movement problems that are severe enough to impair vision.

Ghosting

Some people with MS may also experience double vision or diplopia

. Diplopia occurs when the muscles in the eyes are out of sync because one eye is not working correctly. As a result, the brain struggles to assemble a clear image.

Blindness

In advanced stages, MS can destroy the protective covering around the nerves, causing permanent vision changes. For a person who regularly experiences vision problems during flares, this may result in partial or complete blindness in one or both eyes.

Main symptoms

Signs of multiple sclerosis depend on the location of the main part of the pathological foci. As new areas are affected, the symptoms increase and become more varied.

Damage to cranial nerves

Most often, multiple sclerosis affects the optic nerve, which is responsible for image perception. Often these symptoms are the first signs of the disease:

a sharp decrease in visual acuity in one of the eyes;
feeling of a veil, haze, black dots or spots in the field of vision that do not go away after blinking;
narrowing of the view: blind spots appear in the field of vision (damage to the outer or inner half, as well as narrowing like a pipe - circular);
a sudden change in the perception of one, several or all colors;
constant feeling of a speck in the eye;
blurred outlines of objects;
pain in the eyeball, worsening with eye movement.

The changes persist for 1-2 weeks, after which they disappear completely or partially. Exacerbations occur periodically.

If the oculomotor and abducens nerves are involved in the process, a person may notice the following symptoms:

strabismus;
double vision;
slight drooping of one of the eyelids;
disorders of coordinated eye movement.

Less commonly, the disease affects other nerves, in particular the trigeminal or facial. In this case, the patient notes symptoms characteristic of their inflammation.

Cerebellar lesion

The cerebellum is the part of the brain responsible for the sense of balance and coordination of movements. If multiple sclerosis affects this area, a person experiences the following symptoms:

sudden dizziness or imbalance (including loss of ability to skate, scooter, or bicycle);
unsteadiness when walking: manifested by a short-term sensation of falling or falling to one side;
change in handwriting for the worse;
sensation of objects trembling or appearing double;
Nystagmus: small vibrations of the eyeballs that are noticeable when looking up or to the sides.

Damage to the cerebellum is often the first sign of a developing disease.

Sensory disorders

Damage to the parts of the brain responsible for sensitivity causes the appearance of paresthesia - sensations that occur without any reason. It could be:

tingling;
burning;
itching;
feeling of skin tightness;
crawling of goosebumps;
decreased sensitivity, etc.

Often only one small area is affected: finger, nose, foot, etc. Typically, such problems pass quickly, and the patient does not take them seriously for a long time until the severity of the symptoms becomes much stronger.

The disease can also manifest itself as a violation of temperature, pain or vibration sensitivity, and both a decrease and an increase in sensations are noted.

Pelvic function disorders

Damage to certain areas of the spinal cord leads to specific disorders that force a person to consult a urologist:

Movement disorders

Movement disorders occur at any stage of the disease. They are represented by a wide range of symptoms, including:

problems with fine motor skills (buttoning, sewing, etc.);
muscle weakness of varying severity;
decreased reflexes (detected during neurological examination);
muscle cramps, often occurring at night.

Emotional, mental disorders

This area is not often affected by multiple sclerosis, but as the disease progresses, a person may complain of emotional lability, irritability, memory impairment, apathy, etc.

Multiple sclerosis is characterized by a wide range of pathological foci, which is why signs of the disease are rarely limited to any one area. Often, a person notices several different symptoms at once, which occur simultaneously or replace each other. The doctor’s main task in this case is to tie everything together and prescribe tests that will help confirm or refute the diagnosis.

How long do symptoms last?

MS affects people differently, so there is no way to say exactly how long symptoms will last. Symptoms subside as soon as the inflammation in the nerve cells subsides. For many people, symptoms last several weeks. Others will experience symptoms for more than a year. Some people may find that their symptoms worsen with heat, such as after a hot shower or on particularly hot days. A rise in body temperature after exercise or a cold can also make symptoms worse. Symptoms may worsen when a person strains their eyes throughout the day. Therefore, it is necessary to take regular breaks throughout the day to rest your eyes and avoid unnecessary strain.

Causes

Eye symptoms occur when the immune system attacks the myelin sheath of the nerves that control various aspects of the eye. The type of symptoms a person experiences will depend on which nerves are damaged. MS is not the only cause of optic neuritis. Other factors can cause inflammation in the eyes and lead to symptoms. This:

some medications;
viral or bacterial infections such as Lyme disease, mumps, or measles;
other autoimmune conditions, including lupus or sarcoidosis.

Scientists don't know the exact cause of MS, but there is evidence that several environmental factors influence the risk of developing MS, including:

smoking cigarettes;
low vitamin D levels;
Epstein-Barr virus infection.

However, increased risk does not mean that these factors directly cause the disease.

Multiple sclerosis: what is this disease?

Multiple sclerosis (MS) is an autoimmune chronic pathology accompanied by damage to the upper layer of nerve fibers in the brain (brain and spinal cord).

Human nerves are covered by the so-called myelin sheath, whose task is to protect thin fibers from negative influences. When the structure of this surface layer is destroyed, plaques—defective areas—are formed. As a result, the signal transmitted from the brain centers to the organs reaches poorly or does not reach at all, which leads to disruption of many body functions, including visual.

The concept of “autoimmune pathology,” which is often used to describe multiple sclerosis, means that abnormalities in the functioning of the body’s own immune system lead to the development of the pathological process. Simply put, the immune system mistakes its own cells for foreign ones and begins to destroy them. Some cells are replaced by others, resulting in the formation of scar connective tissue in place of the nerve fibers.

Many people mistakenly associate the term “multiple sclerosis” with memory problems in older people. In fact, the disease we are talking about involves a different type of disorder and often develops at a young age. Most often, the disease is detected in patients in the age range of 15-40 years, although there are cases where multiple sclerosis was found in two-year-old children.

Statistics show that the incidence rate of multiple sclerosis is approximately 25 cases for every 100 thousand people. And this is the second most common cause that leads to neurological disability at a young or young age.

Diagnostics

To properly diagnose eye problems associated with MS, doctors need to rule out other conditions. To do this, doctors may order tests to check for MS or other problems. These tests may include:

vision test;
tests;
ophthalmoscopy;
imaging tests such as MRI;
lumbar puncture.

Even if a person already knows they have MS, careful diagnosis is necessary to avoid misdiagnosis of another underlying problem.

Treatment

Most vision problems that occur as a result of MS go away on their own. But taking medications to relieve the symptoms of MS is necessary. Doctors may recommend additional treatment if a person experiences severe symptoms. For example, if a person has vision loss, a doctor may recommend intravenous steroids. In other cases, simple methods can help. For example, your doctor may apply a temporary patch that blocks one eye, which should correct double vision. Some medications can reduce vision problems.

Prevention

It is not possible to completely prevent eye damage from MS, but you can reduce the likelihood of it occurring. People prone to flare-ups should rest regularly during the day. Doctors may also recommend that people wear glasses with special lenses that help control eye problems and reduce symptoms.

A study in the journal Neurology found that there is a link between vitamin D levels and the severity of optic neuritis. However, this does not mean that taking vitamin D will reduce attacks. But at the same time, some doctors recommend that MS patients take vitamin D supplements to support the body.

Research article on the topic: Epilepsy drugs may protect vision in patients with multiple sclerosis.

Why does vision suffer in MS?

The eyes, as an organ of vision, are closely connected to the brain, where the visual cortex is located, responsible for processing visual data. The optic nerve is a critical pair of cranial nerves that transmit visual signals from the retina to the brain. The quality of vision directly depends on the proper functioning of the optic nerve. It is natural that damage to the membranes of the thin filaments of the nerve substance of the brain negatively affects the condition of the retina and optic nerve.

Neuritis is an inflammatory process in the optic nerve. In the general classification, ascending and descending neuritis are distinguished. The first is called papillitis, and with it the inflammation is concentrated inside the eyeball. Descending neuritis is retrobulbar, and with it inflammation can spread along the entire length of the nerve from the eye to the area of the intersection of nerve fibers, the so-called chiasm.