How Does Multiple Sclerosis Affect the Eyes?

Multiple sclerosis (MS) can cause eye twitching and other eye problems, potentially leading to vision loss or double vision. For some, eye problems may be the first symptom of MS.

In MS, the immune system mistakenly attacks the central nervous system, which includes the brain, spinal cord, and optic nerves. This can cause numerous issues with movement, sensation, and vision problems.

MS vision problems can range from mild eye twitching to more serious conditions.

If you notice changes to your vision, consider visiting an ophthalmologist (eye doctor) as soon as possible. They can help you figure out what’s going on and provide treatment or referrals when appropriate.

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The link between MS and your eyes

Vision problems are common among people with MS. You’ll likely experience vision issues at some point following your diagnosis.

In fact, vision issues may be among the first MS symptoms you experience.

That’s because MS often damages the optic nerve, which is responsible for eyesight.

While the optic nerve is most commonly affected, MS can also affect several other nerves within the eye as the disease progresses.

These nerves help with different aspects of your vision, such as opening or closing your eyes, moving them in different directions, or recognizing colors.

Vision problems may also occur due to a lack of coordinated eye movement.

If you have MS-related vision problems, you may experience symptoms like:

• eye twitching
• pain when moving your eyes
• blurred vision
• partial or total blindness in one eye, worsening during a flare
• loss of color or graying vision
• dull pain behind your eyes
• trouble seeing to one or both sides

The link between MS and eye twitching

When a group of muscles twitches or jerks uncontrollably, it’s known as myoclonus.

Myoclonus can occur on its own, as hiccups do, or as part of a larger collection of symptoms, such as MS.

While eye twitching on its own is uncommon in MS, several eye conditions that can occur with MS can cause uncontrollable eye movements or loss of vision. We address each of these below.

Common vision issues with MS

Several eye conditions are common with MS. They include:

Optic neuritis

Optic neuritis is a common condition in which inflammation causes damage to the optic nerve.

In MS, optic neuritis often occurs as a first sign or symptom of the condition. It typically affects only one eye. While it doesn’t cause eye twitching, optic neuritis does cause other symptoms, such as:

• aching pain with eye movement
• dim, blurry vision
• loss of color vision

The vision loss often clears on its own, but treatments can help. You may also experience vision loss in the other eye at some point in the future.

While optic neuritis often clears within a few weeks, book a visit with an ophthalmologist or optometrist to determine the cause of your vision issues. They may prescribe steroids in cases that affect your ability to get through your daily routine, like work, driving, or other activities.

Diplopia (double vision)

MS can also lead to diplopia, also known as double vision. When you have double vision, a single image may appear either next to itself or stacked on top of itself. When you cover one eye, however, you’ll notice that your vision returns to normal.

You can experience double vision if the nerves that control eye movement become inflamed and damaged. This can cause your eye muscles to weaken. The subsequent loss of coordination between the eyes creates double vision. Diplopia can also occur when MS lesions occur in the midbrain.

If double vision is a new symptom for you, it may be part of an MS relapse.

Double vision can last for a short or long time. Sometimes, it clears on its own. Other times, you may need treatment, such as corticosteroids. Other treatments, such as wearing a patch over one eye, may also help.

Nystagmus

Nystagmus is a rapid, uncontrolled, involuntary movement of the eyes. While it may seem similar to the more familiar eyelid twitch, nystagmus involves the eyeballs rather than the lids. The eye movements may be:

• from side to side
• up and down
• all around

Though it can affect your vision, not everyone with nystagmus notices changes in how they see things. Instead, you may only discover you have it when a doctor tests your eyes.

Some people may also only notice nystagmus when consciously attempting to look in a specific direction, like to the side or straight ahead.

Others may experience what’s known as oscillopsia, in which objects seem to wiggle, jerk, or move back and forth. This can lead to vertigo, or a sensation of the world spinning around them. It can cause balance issues, nausea, or vomiting.

Heat, stress, or being tired can worsen symptoms.

Treatments may include anticonvulsant medications, such as gabapentin or clonazepam, or muscle relaxants, such as baclofen or botulinum toxin (Botox).

Internuclear ophthalmoplegia

Internuclear ophthalmoplegia (INO) occurs when a lesion on the brain prevents your eyes from working properly with each other.

People with INO have difficulty rotating the affected eye toward the center of the body. For example, if you look to the left, your right eye may continue looking straight ahead.

Some people with INO may experience double vision or blurry vision. People with INO in just one eye may also experience nystagmus in the opposite eye.

However, in MS, INO often affects both eyes. The condition affects up to 23% of people with MS.

Alternatively, INO may show up in some people as “one-and-a-half syndrome.” When this occurs, one eye can only look straight ahead, and the other eye can only look outward but not toward the center of the body.

Most people, including people with MS demyelination, recover from INO.

People who develop diplopia as part of their INO may need additional treatments, such as Botox injections or prisms.

Prisms are special glasses that help align a person’s vision so they only see one image. Botox injections may help rebalance eye muscles to reduce diplopia and improve binocular function.

Other causes of eye twitching

Everyone has probably experienced brief (or not so brief) episodes of one eyelid twitching, medically known as myokymia.

It’s relatively common, even in people without MS. An occasional twitch is generally harmless. It won’t cause any vision loss or issues with the eyes.

When these twitches occur, they’re generally caused by one or more factors, such as:

• stress
• dry eyes
• too much caffeine
• sleep deprivation

If your eye twitching lasts more than a few days, consider visiting an eye doctor for a diagnosis and treatment.

The takeaway

MS can cause several issues with the eyes. While eyelid twitching is usually not related to MS, other visual problems are, and they can lead to impaired vision. Vision problems may be the first symptom of MS.

Visit an eye doctor anytime you develop a sudden onset of vision loss or other visual disturbances. Though MS may not be the cause, your eye doctor can figure out what’s going on and prescribe treatment as needed.

If you’re already living with MS and develop worsening or new vision issues, visit an eye doctor as soon as possible. This could be a sign that you’re having an MS relapse or need a change in treatment.