Tried covering MS pathogenesis in terms of its ocular symptoms.

1. MULTIPLE SCLEROSIS & ITS
OCULAR MANIFESTATIONS
-Prathamesh Shasane
B016
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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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