Visual Changes

Vision problems are among the most common early and ongoing symptoms of multiple sclerosis (MS), affecting more than half of people with MS at some point in their journey. They can significantly impact daily activities such as reading, driving and social interaction, making timely identification and management essential.
What Are Vision Problems in MS?

Vision problems in MS encompass a range of disturbances caused by damage to the optic nerve or the brain pathways that control eye movement. The main types include:

  • Optic neuritis: Inflammation and demyelination of the optic nerve leading to sudden vision loss or blind spots, pain on eye movement and reduced colour perception.
  • Double vision (diplopia): Seeing two images of a single object due to weakened or uncoordinated eye muscles from demyelination in brain areas controlling eye movement.
  • Involuntary eye movements (nystagmus): Rapid, rhythmic eye movements—horizontal, vertical or rotary—that can cause blurred vision, dizziness and imbalance.

Vision problems in MS arise from the immune system attacking myelin—the protective coating of nerves—in the central nervous system:

  • Optic neuritis: Autoimmune inflammation damages optic nerve myelin, disrupting transmission of visual signals from eye to brain and creating central scotomas or blind spots.
  • Diplopia: Lesions in brainstem pathways impair coordination of eye muscles, causing misalignment and double images.
  • Nystagmus: Demyelination in cerebellar or brainstem regions responsible for gaze stability leads to involuntary eye oscillations.

Heat, fatigue and stress may exacerbate these symptoms by further impairing nerve conduction.

  • Seek prompt assessment: Contact your neurologist, MS nurse or GP at the first sign of blurred, double or painful vision to exclude infections and assess inflammation.
  • Undergo eye examination: Tests such as visual acuity, colour vision, optical coherence tomography (OCT) and MRI help determine the extent of optic nerve damage and guide treatment.
  • Track symptoms: Keep a vision diary noting onset, duration and triggers to inform your healthcare team’s management plan.
  • Eye patching or prism glasses: Temporarily patching one eye or using prism lenses can alleviate double vision when acute.
  • Cooling strategies: Apply cool packs or wear cooling garments to reduce heat-induced vision worsening.
  • Rest and pace activities: Avoid eye strain by taking regular breaks from reading or screen use. Maintain good lighting and ergonomic setups.
  • Balance support: Use handrails and mobility aids if vision problems increase fall risk.
  • Optic neuritis: Often resolves in 4–6 weeks; corticosteroids (oral or intravenous) may speed recovery but do not alter long-term outcome.
  • Diplopia: Acute double vision may improve spontaneously or with steroids; persistent cases can benefit from botulinum toxin, surgery or prism-corrected glasses.
  • Nystagmus: Treatment options include medications (e.g., gabapentin, baclofen) and specialized lenses, though response varies; referral to a neuro-ophthalmologist is recommended.
Your healthcare team will tailor a personalised plan combining pharmacological and non-pharmacological strategies to optimise vision and function.

General Information

Living with MS-related vision problems can be challenging, but support is available:

  • MS Auckland, Wellington, Canterbury, etc. – Regional societies providing local support, information, and services for people with MS in their areas.
  • Healthline – 0800 611 116 – Free health advice from trained registered nurses, available 24/7.
  • Disability Connect – 09 636 0351 – Information, advice, and support for families of people with disabilities.
  • Work and Income New Zealand – 0800 559 009 – Information about financial assistance that may be available to you.

Symptoms

Understanding MS