Multiple Sclerosis and the Ophthalmologist

Ellen M. Mowry, MD; Laura J. Balcer, MD, MSCE; Steven L. Galetta, MD


Compr Ophthalmol Update. 2007;8(1):39-49. 

In This Article

Abstract and Introduction

Multiple sclerosis is a common demyelinating disorder of the central nervous system, and neuro-ophthalmologic manifestations occur in the majority of patients. This article provides a review of the pathogenesis, epidemiology, and classification of multiple sclerosis. Neuroophthalmologic abnormalities associated with multiple sclerosis, including acute demyelinating optic neuritis and internuclear ophthalmoplegia, are described in detail. Current and emerging technologies designed to assess visual function in multiple sclerosis are discussed. A summary presents the appropriate evaluation and management of patients with optic neuritis and other first demyelinating events (also referred to as clinically isolated syndromes).

Multiple sclerosis (MS) is the most common demyelinating disorder of the central nervous system (CNS). Afferent visual dysfunction and ocular motility deficits are frequent causes of disability in MS, and they may be the initial manifestations of the disorder in approximately 50% of patients. The ophthalmologist plays an important role in the recognition of first demyelinating events in MS and may also provide helpful guidance to patients with known MS whose visual function has been affected by acute or chronic manifestations of the disease. Since early treatment with disease-modifying therapies is now recognized as an important factor in delaying the accumulation of magnetic resonance imaging (MRI) lesions and the development of future clinical attacks in patients with first demyelinating events (also referred to as clinically isolated syndromes), this review will focus on the management of clinically isolated syndromes while also presenting an overview of common ophthamologic manifestations of MS.


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