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Neuro-Ophthalmology and Multiple Sclerosis

Correspondence: Requests for reprints should be addressed to: Charles E. Maxner, M.D., Division of Neurology, 1796 Summer St., Halifax, Nova Scotia, Canada B3H 3A7.

Purpose: To describe the pertinent neuro-ophthalmic disorders seen in multiple sclerosis (MS).

Methods: Literature pertinent to the discussion of both the afferent and efferent neuro-ophthalmic disorders seen in MS are reviewed. This review is supplemented with illustrative case reports to demonstrate the hallmark issues in regards to demyelinating disease and its effect on the visual system.

Results: Numerous disorders of vision can be caused by the central nervous system lesions of MS, but the main findings are optic nerve dysfunction in the afferent visual system and internuclear ophthalmoplegia and nystagmus in the efferent visual system. Magnetic resonance imaging has revolutionized the ability to correlate the patient’s presentation with the etiologic CNS lesion and as well has become a cardinal component of the diagnostic criteria of MS. Early diagnosis is now being emphasized as immunomodulatory treatments exist that have altered the natural history of MS.

Conclusion: It is important to carefully assess the neurovisual system in patients presenting with even minor neurologic complaints. Abnormalities seen on exam could indicate the presence of a subtle organic disorder that triggers investigatory studies that may reveal CNS demyelination (MS). Early diagnosis and treatment of MS are being emphasized for optimal patient care.

Key words: multiple sclerosis, optic neuritis, visual fields, internuclear ophthalmoplegia, MRI