Vision Issues and Treatments

Problems with vision are a common first symptom of MS and can appear quite suddenly. Thankfully, vision issues will usually resolve with proper treatment and time. Proper treatment will often consist of a round of IV steroids, and possibly oral steroids as well. Optic Neuritis is the most well known vision issue in the MS community, however there are several others that can show up as well, which we will dive into! What first brought me to the doctor, was a case of Optic Neuritis, so I am also lumped into this category: “vision issue as first symptom” .

When I was thinking about this topic, I wanted to know why vision issues are usually the first sign our bodies are in distress. Why is that such a common thread? There must be something there. Currently, the only thing I can find is that is a “definable” symptom. It’s not vague like numbness or tingling. There is actually data that can be collected when vision fails, a doctor can see the nerve that is angry and hurting. But there has to be more, the hunt for information will go on.

OPTIC NEURITIS

Optic Neuritis is caused by inflammation of the optic nerve, which connects the eye to the brain. The inflammation causes the symptoms which include eye pain, changes in color perception, graying of vision or loss of peripheral vision. It usually affects one eye at a time, but can affect both eyes, however, that is rare. Optic Neuritis can happen once, or multiple times during a persons life, as with everything else, it’s all individualized.

Treatment for Optic Neuritis is usually done with IV steroids, and occasionally a taper with oral steroids. As with most symptoms, steroids will calm inflammation, but will not speed the return to “normalcy” or change how well you’ll see after the episode of Optic Neuritis has cleared. Most individuals will find they eventually return to 20-20 vision in high contrast situations, so bright daylight they see fine. However, many individuals find that in low contrast situations, like dawn or dusk, their visual acuity/sharpness is still impaired. Some individuals find that their vision issues linger long after the inflammation has cleared, and this can lead to becoming legally blind.

DIPLOPIA

Diplopia is “Double Vision” that can be caused by a variety of things, but mostly caused by the eye muscles being weak or imbalanced, which causes the two images created by the eyes to not be fused together properly. It can also be caused by lesions in the brain stem or cerebellum. Diplopia can come and go, especially if fatigued or if straining your eyes (working on your computer too much?) and will often improve with rest.

Diplopia will usually resolve itself without treatment, but for some acute cases, IV steroids might be needed. Often times patching an eye for a short periods throughout the day (like for driving) might be helpful, but isn’t used in long term treatments as the eye will become weaker and accustomed to the non-use. There are special eye glasses that can be used in treatment as well, and also surgery, but that should be considered as a last resort, as resolving Diplopia can take a year or more in some cases.

NYSTAGMUS

Nystagmus is when the eyes will make uncontrolled, rapid, vertical or horizontal movements and is caused by damage to nerves and parts of the brain that control eye movement. Often times this occurs during a relapse, but may continue afterwards as well. These movements may be mild and unnoticed by the individual (only noticed by those worried individuals around them) or they may be more severe and interfere with vision. If severe enough to be noticed by the individual, Nystagmus may cause issues with depth perception and balance. Someone with severe Nystagmus may perceive their world as always moving and can contribute to feeling sick or unbalanced. Medication and special eyeglasses are the common treatments for this issue.

MY VISION JOURNEY

As I alluded to earlier, I started out my MS journey with Optic Neuritis, this is what first prompted me to head to the doctor. After several weeks of blurry vision in my left eye, I figured I should get it checked out. A few eye exams, some MRI’s, and a spinal tap later, I had an MS diagnosis. However, I never got direct treatment for the Optic Neuritis. Once we finally figured out what it was, it had been about a month since it began, a bit late to start IV steroids, so said the doc. So I just let it run it’s course, which ended up being fine. I don’t remember how long I dealt with the symptoms of it for, I just know it eventually went away. Now, when I get overheated, my eyesight starts to fade, and when it is low light, I have trouble seeing. But overall, I have my vision back.

Regardless of the vision issue that you may be experiencing, there are treatments available and a positive prognosis ahead. The vast majority of individuals will regain their vision, it may just take some time. But that seems to be the case with everything else in the MS world, right? I feel a new saying coming on.. “Time heals all…relapses?”

As always, let me know your thoughts in the comments! I love hearing from you!

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