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    You are here : Home » About MS » Symptoms » Visual Disturbances

    Visual Disturbances

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    There are basically three main types of Visual Disturbances in MS, however there are several minor ones as well, overlapping with these. The three main types are Optic Neuritis, Nystagmus and Diplopia (double vision).


    Nystagmus is a condition in which the eyes move in a more or less rhythmical manner, from side to side, up and down, or in a rotating manner from the original point of fixation. This sometimes goes unnoticed by the person with MS but is clearly seen by a doctor or optician. To others it resembles the eye movements when someone is looking at the scenery from the window of a moving vehicle.

    It can occur in one eye or both and, if in both of them, simultaneously or separately. Horizontal nystagmus is usually due to a disturbance in the vestibular system. It typically causes general poor vision and, often, loss of balance.

    It is often caused by a lesion in an area of the brain called the medial longitudinal fasciculus (MLF), but also by lesions in the cerebellum, the area of the brainstem where the vestibular cranial nerve arises or further along the vestibular pathways.

    Although quite a common symptom, it can be a difficult symptom to treat. Depending on the severity i.e. if it interferes enough with daily life then drug therapy can help and very recently the use of a muscle relaxant injection (botulinum) into the eye muscles has been shown to be effective but apart from immunomodulating drugs and steroids, there are no other treatments for nystagmus.

    If it is a troubling condition it may be a good idea to experiment with different lighting levels or tinted lenses. As with most symptoms of MS, fatigue and heat (Uhthoff's symptom) usually make the condition worse. It can temporarily reduce vision.

    Fortunately, the prognosis for recovery from many vision problems associated with MS is good. There is work being done on optical devices to stabilise the ‘wiggling’ visual environment of people with nystagmus and moreover, the brain eventually learns to ignore the ‘wiggling’ type of vision disturbance.

    Personal Experiences of Nystagmus

    “I have had this in the past and don’t have much to say other than I feel as though I have to chase things around the page when reading.”

    “ It only really seems to affect my right eye but as far as I know there isn’t really anything you can take for it. I had it before and at that time a course of steroids rectified it along with other stuff but this time it came on after the steroids finished.”

    “I've had this on and off since my early twenties. I can remember going for an EEG because I was being investigated for epilepsy. It was very difficult to keep my eyes from jerking as requested but I finally got through the EEG.”

    “I go through periods of not being able to read because I can't follow the words though a coloured perspex overlay helps with this.”


    This can be a very early symptom of MS without people realising it. It is usually caused by lesions in the brainstem where the cranial nerves serving the eye muscles arise. This disturbs vision by producing images in double. It may also cause loss of balance because spatial orientation is disturbed.

    The sudden onset of double vision, poor contrast, eye pain, or heavy blurring can be frightening. Fortunately, the prognosis for recovery from many vision problems associated with MS is good.

    It is re-assuring to remember that double vision is temporary.

    What causes Double Vision?

    Double vision may increase with fatigue or overuse of the eyes, for example, with extended reading or computer work, and improve with rest. Resting the eyes periodically throughout the day can be beneficial.

    Are there any treatments for Double Vision?

    1. The wearing of an eye-patch over one eye can alleviate the problem and it makes little difference which eye to cover; it is a matter of the person trying to see which works best for them. The visual image focuses in different areas of the retinas in your two eyes, too far apart for the brain to merge them. This means the double vision goes away when you cover one eye. This is not recommended for long periods but useful for driving and performing short tasks.

    2. Applying frosted tape to one lens if the person with MS wears glasses, for the same reason as above.

    3. An optician may prescribe glasses with prisms but as the symptom is usually transitory, it’s up to the person to decide whether or not these are really necessary.

    4. Pin hole glasses can often help some with double vision.

    5. Steroids are occasionally used to treat diplopia associated with relapsing-remitting MS but they have been shown to only affect the rate and not the amount of recovery.

    Personal Experiences of Double Vision

    “I had double vision for what felt like two months but was in fact about 14 days. It meant I couldn't drive my car which was purgatory, but apart from that it wasn't too troubling. It’s just the not knowing when, or if, it would end which was distressing.”

    “I had it at the same time as a particularly nasty urinary tract infection and it lasted 6 weeks to the day - I remember because it was a textbook case apparently. That was about 10 years ago, and I have had no problems since.”


    This very common symptom of MS was discovered by Wilhelm Uhthoff a renowned clinical neuro-ophthalmologist. Uhthoff noted in 1890 while studying MS patients that their symptoms worsened after exercise. It was later discovered to be related to the rise of body temperature which eventually led to the 'hot bath test' in the 1950s.

    This was to remain the principal diagnostic tool for MS for over thirty years, with the practice ending in the 1980s when more accurate technical testing methods became available.

    The Uhthoff induced symptoms tend to go away as the body returns to its correct temperature after anything from several minutes to a few hours has passed.

    What Causes Uhthoff's Symptom?

    The simple answer is that no-one can pinpoint the exact cause but is thought that it may be caused by many factors.

    One explanation of Uhthoff's symptom is that heat causes a blockade of partially demyelinated axons. Other theories suggest that heat itself, effects of serum calcium, blockade of ion channels, circulatory changes, and unidentified blood serum substances.

    To avoid, or at least, minimise the effects of heat, MS patients are advised to use cooling products, especially during the summer months. It is comforting to know that this symptom tends to go away as the body returns to its correct temperature after anything from several minutes to a few hours has passed and that vision is restored with no residual damage having been caused.


    This can be caused by Optic Neuritis or heat related vision disturbances e.g. Uthoff’s Symptom and can affect just the one or both eyes.

    Colours are described as being darker or washed out with people frequently remarking that their vision in the affected eye or eyes is’ not quite as it was’. There might be subtle things to do with picking up colour or colour contrasts, depth, perception or some loss of visual sharpness, even though an eye-test test might prove that vision itself is still within normal limits.

    Personal Experiences

    “I only noticed this by chance when lying in bed one morning gazing towards my wardrobe firstly with one eye, then the other. I saw two differing shades of brown.’

    “I queried this with my optician during an eye test because I was tested for normal colour blindness e.g. the thing about reds and greens, but he told me it was just caused by MS. I don’t find it particularly distressing though I have to read clothes labels because I’m never sure if something is navy or black.”

    © Multiple Sclerosis Resource Centre (MSRC)

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