Elsevier

The Lancet Neurology

Volume 4, Issue 2, February 2005, Pages 111-121
The Lancet Neurology

Review
The neuro-ophthalmology of multiple sclerosis

https://doi.org/10.1016/S1474-4422(05)00992-0Get rights and content

Summary

Multiple sclerosis (MS) is the most common disabling neurological disease in young people. Most CNS lesions involve neuroanatomically non-eloquent zones that often do not result in symptomatic complaints. By contrast, tissue-injury mechanisms involving inflammatory demyelination can involve more eloquent sites, such as the optic nerve and brainstem, which can correspondingly produce the development of well recognised syndromes such as optic neuritis and internuclear ophthalmoplegia, respectively. In this review we discuss the broad landscape of abnormalities that affect the afferent visual system and the ocular motor apparatus, and emphasise relevant features, the recognition and treatment of which are of importance to general neurological practice. The commonness of visual sensory and eye movement abnormalities in MS highlights the importance of understanding the principles addressed in this review.

Section snippets

Optic neuritis

Acute idiopathic demyelinating optic neuritis is frequently the initial clinical manifestation of multiple sclerosis. Although there is a broad age range for onset, most patients with acute demyelinating optic neuritis are young, age 20–50 years. There is a gender difference: women are three times as likely as men to develop optic neuritis. The incidence of acute demyelinating optic neuritis is about three per 100 000 people in the USA; in low-risk regions such as Japan, the incidence

The clinical–radiological paradox

Most CNS lesions in MS are not associated with identifiable clinical findings. This is perhaps related to a high predilection of tissue damage within non-eloquent zones of cerebral white matter, including the cerebral periventricular zones, the centrum semiovale, and corona radiata. By contrast, there are discrete neuroanatomically eloquent sites where the pathological process in MS results in stereotyped and easily recognised syndromes such as internuclear ophthalmoplegia.52

Assessment of the ocular motor system and disorders of fixation in MS

When done

Search strategy and selection criteria

Data used in the development of this review was derived from searches in MEDLINE, PubMed (without restriction to the year of publication), and through the authors' extensive files. The search terms were “Multiple sclerosis” combined with: “Optic neuritis”, “uveitis”, “nystagmus”, and “eye movements”. The search was completed in June, 2004.

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