Concerned

[KN33]

I was diagnosed with MS 2 weeks ago but it took almost a month to find out. I have had double vision and eye irritation during this time. My question is-is it too late to get steroid treatment? Will my vision ever be normal again?

[doublevision1]

ps: I should also add that my neuro's explanation for the eventual improvement of my diplopia was likely not due to re-myelination of the crnaial nerves involved, but more likely a result of 'brain plasticity' meaning when the affected nerves stopped working properly due to loss of myelin, other nerves kicked in and took over proper function.

There's a lot more to it than that, but that's my layperson's understanding/recollection of his explanation.

[doublevision1]

I had a severe case of horizontal left lateral diplopia that started just prior to my official MS dx in 2007, and lasted approx one year.   I had had IVSM approx 4 weeks after it started and didn't seem to result in any speedier improvement (though the IVSM did help other symptoms incl. MS hug).  My diplopia improved at a snail's pace over the course of my first year living with MS.   There is no treatment beyond IVSM, though I did see my ophtha and neuro-ophtha regularly so they could chart my improvement.  It ultimately improved to about 95%; I still have it on my far left lateral gaze.  Also, it does return while exercising, with a fever, etc due to Uthoff`s phenomenon, but this is temporary and corrects itself once my temp returns to normal.

Living with diplopia requires extreme patience as you wait for it to improve.   Eyeglasses with temporary prisms can be used to trick the eyes into seeing only one image; this can be helpful for reading, driving, etc.  I was never able to use them because of the slow but steady improvement in my eyes.  Each time they would improve a new prism with different measurements would be needed.  This is why it is best to wait if you're considering permanent prisms.  They are expensive so one ought to wait until it's obvious there will no longer be improvement, then order them based on current measurements.  In my case, I ended up not getting them because the 95% improvement is enough that I don't need them.  In the short term, an eye patch over either eye will allow you to see one image, though while wearing it will impair peripheral vision in the covered eye.

I'd encourage you to visit your ophthalmologist regularly, or even better, get a neuro-ophtha, and have them measure your double vision each time.  This will inform you as to whether you are improving or not; sometimes it is so subtle you won't notice it so the objective testing is worthwhile.

I`ve also had optic neuritis but this didn't cause or worsen my diplopia.  In fact I didn't know it could as per Lulu's note.  For me optic neuritis was all about blurred vision in the affected eye and PAIN.  



My neuro explained to me that my diplopia and associated nystagmus were a result of internuclear ophthalmoplegia / 6th cranial nerve palsy.

A blurb on this from wiki:
"Internuclear ophthalmoplegia (INO) is a disorder of conjugate lateral gaze in which the affected eye shows impairment of adduction. When an attempt is made to gaze contralaterally (relative to the affected eye), the affected eye adducts minimally, if at all. The contralateral eye abducts, however with nystagmus. Additionally, the divergence of the eyes leads to horizontal diplopia. That is, if the right eye is affected the patient will "see double" when looking to the left, seeing two images side-by-side. Convergence is generally preserved.

The disorder is caused by injury or dysfunction in the medial longitudinal fasciculus (MLF), a heavily-myelinated tract that allows conjugate eye movement by connecting the paramedian pontine reticular formation (PPRF) -abducens nucleus complex of contralateral side to the oculomotor nucleus of the ipsilateral side.

In young patients with bilateral INO, multiple sclerosis is often the cause. In older patients with one-sided lesions a stroke is a distinct possibility. Other causes are possible."



And another blurb from Merck:
"Internuclear ophthalmoplegia is impairment of horizontal eye movements caused by damage to certain connections between nerve centers in the brain stem.

In internuclear ophthalmoplegia, the nerve fibers that coordinate both eyes in horizontal movements—looking from side to side—are damaged. These fibers connect collections of nerve cells (centers or nuclei) that the 3rd cranial nerve (oculomotor nerve) and the 6th cranial nerve (abducens nerve) originate from. In older people, the disorder usually results from a stroke, and only one eye is affected. In younger people, it usually results from multiple sclerosis, and both eyes are often affected. Less common causes include Lyme disease, tumors, and toxicity due to a drug (such as tricyclic antidepressants).

Horizontal eye movements are impaired, but vertical ones are not. The affected eye cannot turn inward, but it can turn outward. When a person looks to the side opposite the affected eye, the following happens:

The affected eye, which should turn inward, cannot move past the midline. That is, the affected eye looks straight ahead.
As the other eye turns outward, it often makes involuntary, repetitive fluttering movements called nystagmus That is, the eye rapidly moves in one direction, then slowly drifts in the other direction.
People with internuclear ophthalmoplegia may have double vision."

[Sparkysarah]

I just want to welcome you to our great forum and am sorry to hear of your recent diagnosis. I expect that the month you were waiting for results felt a very long time but as Lulu indicated this is in fact almost record time for a diagnosis as many people wait years or do not get there at all.

However as Lulu says it will take time to adjust to learning about the condition, understanding how it will affect you and deciding what treatment options are available.

This is a great place to learn more about MS and the health pages are very informative.  Let us know how you get on.

Best wishes

Sarah

[kwarendorf]

It's important to know what caused your double vision. It can be optic neuritis, but it can also be nystagmus.

Optic neuritis is inflammation of the optic nerve. Steroids should help reduce the inflammation.

Nystagmus is involuntary eye muscle movement which can result in double vision. This is what I had/have. There is no involvement of my optic nerve and my actual vision is fine. But when I was mid relapse the messages to my eye muscles got jumbled and my eyes couldn't settle on one thing. This resulted in double vision.

I had 5 days of IV steroids and the issue resolved completely.

[beachcomber13]

Hi K, sorry to hear about your diagnosis. When you are comfortable, please tell us more about yourself and what you have been through.

Take care,
BC

[Lulu54]

Welcome to our special place.  I'm glad you asked this question.  The deal with optic neuritis is tricky.  Steroids will help to speed the recovery and decrease the inflammation, but it won't change the outcome.  Whatever point your vision is destined to return to is going to be there, whether you have steroids or not.  You just get there faster with the steroids.

A month to diagnose your MS?  That is fast for this disease.  You must have all the classic symptoms and left no doubt for the doctors.  I'm guessing that this was a surprise/shock to you?  

You are still very fresh to this idea of living with a chronic disease and I hope you will give yourself time to learn more about MS and how to live with it.  It is a real roller coaster ride of ups and downs as we try to figure it out.

Welcome again and I hope we will see you around,
Lulu

[chrisnrenee]

Its been 4 yrs for me n my eye ain't the same. It took them 2 weeks to dx me and the week i was in the hospital (wen i was dx) i was on iv stroids the whole time