Fast Five Quiz: Neuro-Ophthalmologic Manifestations of Multiple Sclerosis

Christopher Luzzio, MD


April 08, 2020

Figure 1. Optic neuritis with drusen (stereo image).

The most common visual disturbance associated with MS is ON or inflammation of the optic nerve characterized by a subacute unilateral vision loss, flashes of light, and typically pain with eye movement. Other relevant findings include dyschromatopsia (decreased color vision) and worsening vision. Eventually, 40% of patients with MS will have experienced ON. Acute bilateral vision loss is less common in MS, and other etiologies should be considered. Children diagnosed with MS also have ON; however, children have papillitis and anterior optic neuritis more often than adults. Children are also more likely to have more severe vision loss and bilateral ON than adults.

Acute management of ON includes high-dose intravenous steroids. Vision improves approximately 3-6 weeks after onset with risk of permanent vision loss.

ON must be positively identified to avoid misdiagnosis of similar presenting conditions (eg, myelin oligodendrocyte glycoprotein, neuromyelitis optica, lupus-related optic neuropathy, syphilitic optic nerve injury).

Unilateral conjunctivitis, keratoconjunctivitis sicca (dry eye), and unilateral blepharitis are not common visual disturbances associated with MS.

Learn more about ON.


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