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Woman with MS related eye problem - optic neuritis

MS Eye Symptoms & Vision Problems

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Can MS cause vision problems?

Visual disturbance is a common MS symptom. Visual problems with MS may have been one of the first symptoms you sought professional advice for, as something like temporary tingling skin can be dismissed as ‘normal’ and overlooked.

MS vision symptoms include:

  • Involuntary rapid eye movements
  • Pain moving the eye
  • Reduced colour vision
  • Double vision (diplopia)
  • Vision floaters
  • Dizziness
  • Blurred or hazy vision in one eye
  • Vertigo
  • Visual loss

Visual symptoms can be a result of lack of coordination in the eye muscles or damage to the optic nerve which connects the eye to the brain. Damage or inflammation (Uveitis/Pars Planitis) of the optic nerve means you experience a disturbance or temporary loss of vision.

Types of MS vision problems

You may find that your MS visual problems affect just one eye or both, and may come and go. Sometimes the problems disappear completely, while others become more permanent. 

Common types of vision problems caused by MS include:

Double vision (diplopia) and MS

Double vision occurs when your eyes send two images to your brain instead of one. This confuses your brain and is caused by damage to the brain stem, which helps to coordinate your eye movements. 

Nystagmus and MS

Nystagmus is when you find yourself involuntary moving your eyes. It is caused by damage to nerves in the brainstem. The movement is often rhythmic and results in a jerking or jumping sensation in the eye, particularly at the edges of your gaze. This can make you feel nauseous or dizzy.

You might also feel like the world is swaying from side to side or up and down  – this is called oscillopsia and is caused by MS affecting the cerebellum (the brain’s coordination centre) or your inner ear. You might feel this is worse when you look in a particular direction.

Optic neuritis and MS

Optic neuritis is a common early MS symptom, but can also be a condition in its own right and doesn’t always result in MS. It can cause pain on movement of the eye, as well as changes in colour perception and visual acuity. 

You will often find that your vision gradually returns to normal within six weeks to six months after a case of optic neuritis.

MS eye floaters

Eye floaters are a relatively common vision problem among people with MS. Eye floaters are small shapes that drift across your vision. People describe them as:

  • Black or grey specks
  • Thread-like strands
  • Cobwebs
  • Transparent squiggles
  • Small shadowy dots

MS affects the optic nerve (optic neuritis) or the brain’s visual pathways which is why you may experience these symptoms.

Most floaters are harmless but if you want to proactively manage them you can:

  • Monitor changes (increase in number, associated flashes, changes in peripheral vision)
  • Adjust lighting (dark modes, dim screens, supporting glasses)
  • Eye movements (looking up and down quickly can temporarily shift floaters)
  • Medical treatment (victrectomy or laser vitreolysis)

Can an optometrist identify MS through eye symptoms?

Optometrists and neurologists can both play important roles in identifying multiple sclerosis (MS) through eye symptoms, though their involvement and diagnostic tools differ:

Dr Aaron Boster, a neurologist, helps ‘decode’ what you might see in an eye exam:

Optometrists may be the first to notice signs suggestive of MS, especially if a patient presents with:

  • Optic neuritis: A common early symptom of MS, involving inflammation of the optic nerve. Symptoms include: Sudden vision loss or blurring (usually in one eye) and  pain with eye movement
  • Diminished color vision
  • Nystagmus: Involuntary eye movements that can be associated with MS.
  • Abnormal visual fields or afferent pupillary defect (APD)

However, optometrists cannot definitively diagnose MS. If they suspect MS, they refer the patient to a neurologist for further testing.

Neurologists are the specialists who diagnose and manage MS. They will assess eye symptoms in the broader context of neurological health. They may order:

  • MRI of the brain and spinal cord to look for MS lesions
  • Visual Evoked Potentials (VEPs) to detect slowed visual signal transmission (often due to optic neuritis)
  • Lumbar puncture to check for MS-specific proteins 

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How long does vision loss last with MS?

Visual loss secondary to optic neuritis is a common presenting symptom of MS. It is often a temporary symptom, and most people will see full or partial recovery in their vision over a few weeks to months.

Preventing MS vision disturbances

Action you can take:

Experiencing visual problems with MS can be frightening, so it is reassuring to know that there are things you can do to help prevent or reduce the chance of MS eye signs occurring again.

Resting your eyes throughout the day can help manage symptoms

Doctors can prescribe an eye patch to help manage double vision or glasses that contain prisms.

A specific form of neuro physiotherapy, called vestibular rehabilitation can help with abnormal eye movements and reduce the associated symptoms of dizziness and balance problem

Know the triggers that affect your vision and make it worse

Becoming hot might make the MS eyesight issues worse so wear lightweight clothing and stay in the cool during the heat of a summer day. Icy drinks, cooling neck wraps and cooling vests can also help to lower your body temperature. 

On the other hand, feeling cold can increase MS spasticity so it may take some practice to find ways of staying at the most comfortable temperature.

Stress can also trigger MS vision symptoms so incorporate ways of relaxing into your everyday routine – whether that is yoga, massage or meditation – whatever helps you to unwind.

Ask your doctor

If you notice your eye is painful or you have blurred vision or you get a sudden shower of floaters and flashes you might want to contact your MS team or an eye clinic.

For acute cases of optic neuritis, your doctor may prescribe steroids that can speed up your visual recovery, but they don’t have an affect on long-term visual outcomes. It is therefore advisable to combine steroid treatment with other treatments.

Take action on MS fatigue

Lack of sleep and fatigue can also trigger eye problems, or make them worse. You can read about how to manage MS fatigue here. 

What does MS eye pain feel like?

Here’s how people typically describe the pain and related symptoms:

  • Pain with eye movement: This is the hallmark for MS vision symptoms. It often feels like a deep, aching pain behind or around the eye. The pain tends to worsen when you move the affected eye, especially when looking up or to the side.
  • Dull ache: The discomfort is usually not sharp like a scratch or surface irritation, it’s deeper, like a muscle or nerve pain.
  • One eye typically affected: Most cases affect just one eye, though both can be involved.

Accompanying MS Vision Symptoms:

Along with eye pain with MS, you might notice other MS eyesight issues:

  • Blurred or dim vision
  • Washed-out or faded colors, especially reds
  • Blind spots or dark areas in your central vision
  • Decreased visual sharpness
  • “Foggy” vision
  • Temporary vision loss, which can be partial or nearly complete (usually improves over days to weeks)

Duration:

  • Symptoms often develop over hours to a few days, and the pain may last for a week or two, while visual symptoms may take longer to improve.
  • In some visual problems with MS, your vision doesn’t fully return to baseline.
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