People with MS may experience a variety of vision issues, including inflammation of the optic nerve, double vision, and involuntary twitching of the eye muscles.

Multiple sclerosis (MS) is an autoimmune disease that affects the central nervous system (CNS). The CNS includes the brain, spinal cord, and optic nerves.

MS involves the immune system damaging myelin — a substance that surrounds and protects nerve fibers. Damaged areas of myelin are referred to as plaques or lesions.

Demyelinating lesions can affect different parts of the CNS, including the optic nerves. One of the common early symptoms of MS is vision problems, including involuntary eye twitching.

Keep reading to learn more about eye twitching and other vision issues associated with MS.

People with MS sometimes experience myoclonus. Myoclonus is the sudden, involuntary twitching or quivering of a muscle or group of muscles.

It’s a reactive nerve cell misfire that sends the wrong signal to your muscles. This could be the result of demyelinating lesions from MS.

There are a variety of causes for an eye twitch in people with MS, such as nystagmus and internuclear ophthalmoplegia.

Other eye conditions, such as optic neuritis and diplopia, are also known to affect many people with MS.

Optic neuritis is a common vision problem related to MS. It’s inflammation of the optic nerve that can result in blurred vision, pain, and a sudden loss of vision — typically in one eye.

Optic neuritis rarely causes blindness, but it might result in vision blurring or a dark spot in the center of the visual field, known as a central scotoma.

Optic neuritis commonly improves on its own. Based on your specific situation, your doctor might recommend a steroid to help, such as methylprednisolone administered intravenously, possibly followed with oral steroids.

Diplopia is also known as double vision. It occurs when the pair of muscles that control a particular eye movement weaken and become uncoordinated.

When the images are not properly aligned, it results in a double image. Fatigue and overuse of the eyes can increase the effects of diplopia. Double vision may increase with fatigue or overuse of the eyes.

Diplopia is often temporary and resolves without treatment. In some cases, your doctor might recommend a short treatment with corticosteroids.

Nystagmus is a condition that causes uncontrolled repetitive vertical, horizontal, or circular eye movements. The condition makes it nearly impossible to steadily view objects.

Acquired nystagmus is a common symptom of MS and often results in diminished vision and depth perception. It also can affect coordination and balance.

If you have visually disabling nystagmus, your doctor might recommend medications such as:

Internuclear ophthalmoplegia (INO) is damage to the nerve fibers that coordinate both eyes in looking from side to side (horizontal movements). Vertical eye movements are not affected.

If a stroke causes INO (typically in older people), it usually only affects one eye. If MS causes it (typically in younger people), INO often affects both eyes.

INO is seen in about 23% of people with MS. Most people experience a complete recovery.

For acute internuclear ophthalmoplegia, your doctor might recommend intravenous steroid therapy.

The first step for treating any eye movement abnormality is to speak with a neurologist.

If your neurologist is an MS specialist or has been trained in neuro-ophthalmology, they will evaluate your eye condition and create a treatment plan.

If your neurologist does not have a neuro-ophthalmology background, they may refer you to an optometrist or ophthalmologist.