Multiple sclerosis (MS) is a chronic disease characterized by inflammation, demyelination, gliosis, and neuronal loss that typically affects different areas of the central nervous system. The document discusses the pathogenesis of MS including perivascular cuffing, blood brain barrier disruption, astrocytic proliferation, and shadow plaques. It also covers the ocular manifestations of MS such as optic neuritis, internuclear ophthalmoplegia, nystagmus, and ocular motor nerve palsies. Risk of developing MS is about 50% after an acute episode of optic neuritis and 70% for patients with lesions on MRI. Treatment involves steroid therapy and immunomodulatory drugs.

1. MULTIPLE SCLEROSIS & ITS
OCULAR MANIFESTATIONS
-Prathamesh Shasane
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2. INTRODUCTION TO MS
• Multiple sclerosis (MS) is a chronic disease
characterized by inflammation, demyelination,
gliosis (scarring), and neuronal loss.
• Typically affects different times and different
locations of CNS.
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3. PATHOGENESIS OF MS
• Perivascular cuffing
• Blood brain Barrier disruption
• Astrocytic Proliferation (GLIOSIS)
• Shadow plaques
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6. • 70% of axons are lost in from the lateral
corticospinal (motor) tracts in Px with advanced
Paraparesis from MS.
• Initial adaptation, later degeneration
• Remyelinating being the goal.
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7. SYSTEMIC MANIFESTATION OF MS
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• Spinal Cord:- Weakness, Stiffness, Sphincter
disturbances, sensory loss.
• Brainstem:- Diplopia, dysarthria, dysphagia.
• Cerebral:- Hemiparesis, Hemianopia, dysphasia
• Psychological:- Loss of intellect, depression, euphoria.

8. SYSTEMIC MANIFESTATION OF MS
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• Uthoff’s Phenomenon
• Lhirmitte’s Sign
• Pulfrich’s Phenomenon

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10. OCULAR MANIFESTATION
• Optic Neuritis:- Demyelinating Inflammation of the optic
nerve.
• Internuclear ophthalmoplegia
• Nystagmus
• Ocular Motor nerve Palsies
• Hemianopia
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11. ASSOCIATION BETWEEN OPTIC
NEURITIS AND MS
• Risk of developing MS after acute episode of Optic
neuritis is 50%
• 25% in Patients having clean MRI.
• Overall 70% in Patients having 1 or more lesion on
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12. CLINICAL FEATURES OF MS (OCULAR)
• SYMPTOMS:-
– Subacute monocular visual impairment.
– Usual age around 20-50 years.
– Tiny white colored flashes or sparkles (Phosphene).
– Discomfort or pain in or around the eye (90% cases) &
exacerbate during ocular movements.
– Frontal headache and tenderness of globe.
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13. CLINICAL FEATURES OF MS (OCULAR)
• SIGNS:-
– DOV
– Color vision defect, RAPD
– Most of the cases have clear optic nerve, rest have
papillitis.
– Temporal disc palor in contralateral eye.
– Visual Field Defects in entire central 30o
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15. INVESTIGATION
• Lumbar Puncture
• MRI
• For optic neuritis:-
– Visual acuity
– Color vision
– Brightness test
– Pupils
– Ocular Motility
– Ophthalmoscopy
– Visual Fields
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18. TREATMENT
• Indication for steroid therapy
• Steroid Regimen:- IV MethylPrednisolone sodium
succinate 1g daily for 3 days, followed by oral
prednisolone 1mg/kg daily for 11 days;
subsequently tapered over 3 days.
• Immunomodulatory Treatment.
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19. REFERENCE
1. Stephen L. Hauser, S. Andrew Josephson; Harrison’s
Neurology in Clinical Medicine 3rd Edition; Section III,
Chapter 39- Diseases of Nervous System; Multiple
Sclerosis and other demyelinating Diseases; Page 474-
480.
2. Brad Bowling; Kanski’s Clinical Ophthalmology 8th
Edition; Chapter 19-Neuro ophthalmology, Optic
Nerve, Demyelinating optic neuritis; Page 783-784.
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