Ocular Manifestations of Multiple Sclerosis Are Often Among Earliest Signs

Ocular manifestations of multiple sclerosis (MS) are common throughout the course of the disease and, notably, at its onset, suggesting the potential for early detection through ophthalmic examination, according to a review published in the Journal of Neuro-Ophthalmology. The study, which reveals a population-based frequency of MS-related ocular disease, highlights the particular association between the development of MS and optic neuritis, nystagmus, and internuclear ophthalmoplegia (INO).

Researchers included 116 patients with MS (66% women; median age of onset, 36 years [interquartile range, 27.5-43.5 years]). The study, based out of the Mayo Clinic Hospital in Rochester, Minnesota, retrospectively reviewed records of participants with MS who presented between January 1, 1998 and December 31, 2011. For all participants, MS diagnosis was confirmed with neuroimaging, cerebrospinal fluid studies, and serum studies. Patient data were obtained using the medical records and followed through April 1, 2018. It is the first population-based study evaluating these ocular manifestations in MS.

Most commonly, MS-related ocular conditions in this study included optic neuritis (37%), INO (16%), and nystagmus (13%). Optic neuritis was mostly unilateral (40/43, 93%), with 16% (6/43) having a visual acuity of 20/200 or worse, but most (95%, 35/37) ultimately improved to 20/40 or better.

The findings show that more than half of patients with MS develop ocular symptoms at some point, with more than a quarter (28%) demonstrating visual symptoms at presentation.

“Our data suggest that INO and nystagmus are fairly common in MS at rates of 16% and 13%, respectively, whereas other neuro-ophthalmic and uveitic symptoms are less common. In our cohort, there were no cases of MS-associated uveitis or pars planitis, suggesting an incidence of less than 1%, which supports the rarity of this presentation that has been previously reported to be 1% in a nonpopulation-based cohort,” the researchers explain. “We also found that optic neuritis, INO, and nystagmus present slightly earlier than other neuro-ophthalmic manifestations of MS and that the majority of cases (70%) had with a single neuro-ophthalmic manifestation, whereas the remaining 30% had 2 or more neuro-ophthalmic deficits.”

This research is limited in its retrospective nature, primarily White patient base, and a potential overrepresentation of ocular manifestations in multiple sclerosis.

This article originally appeared on Ophthalmology Advisor