Multiple Sclerosis

Multiple sclerosis (MS) is an autoimmune disease that causes your body to produce antibodies that mistakenly attack the myelin sheath protecting your nerve tissue. This chronic central nervous system disorder damages the nerves and causes the gradual loss of muscle control, strength, and vision.  Often, the first symptom a person experiences is changes to their vision, and an ophthalmologist is frequently among the first specialist to help in the diagnosis of this disease.

MS affects people differently. Some have only mild symptoms, while others are severely debilitated by the disease. Symptoms of MS vary widely and can include the following:

  • numbness, tingling, or weakness in the arms and legs;
  • loss of some or all vision, usually affecting one eye at a time;
  • double vision;
  • blurred vision;
  • pain, including eye pain;
  • tremors;
  • coordination difficulties; and
  • dizziness.

If you are experiencing any of these symptoms, it is important to see your doctor immediately. To determine if you have MS, your doctor will take a complete medical history, and you will be given a neurological examination. You might also need an MRI and other tests to diagnose the cause of your symptoms.

Should your doctor confirm that you have MS, there are a number of treatment options. If your symptoms are mild or infrequent, you may require no treatment other than careful monitoring. For more serious cases, there are several medications that can help, as can physical therapy, occupational therapy, and other treatments.

Though there is no cure for multiple sclerosis, the major causes of vision problems associated with the disease are all treatable, and they often resolve on their own. Three common visual problems associated with MS are:

  • optic neuritis, or inflammation of the optic nerve, causing blurring, pain, and blind spots, among other things;
  • diplopia, or double vision; and
  • nystagmus, or involuntary movement of the eyes.

Steroid medications are commonly prescribed for all three conditions. Patching, prism eyeglasses, and perhaps surgery are also effective in treating double vision. Nystagmus may respond to some medications other than steroids, as well. Over time, your brain may adjust to the appearance of black spots and wiggly lines associated with nystagmus, restoring much of your normal vision.

Myasthenia Gravis

Myasthenia gravis (MG) is a disorder characterized by weakness of the muscles under your voluntary control. MG is caused by a communication breakdown between your nerves and muscles due to an autoimmune condition that has damaged receptors on your muscles. Your autoimmune system is producing antibodies that are adhering to these receptors, blocking chemicals that normally travel from your nerve endings to the receptors.

MG most often affects the muscles of the face, eyes, arms, and legs, as well as the muscles used for chewing and talking. The muscles that control breathing and swallowing can sometimes be involved as well. These are some of the signs of myasthenia gravis:

  • drooping eyelids;
  • double vision;
  • weakness in the arms or legs; and
  • difficulty breathing, talking, chewing, or swallowing.

MG can be made worse by fatigue, stress, illness, and by certain medications. Check with your doctor before taking any new prescription or over-the-counter medications. Extreme difficulty with breathing or swallowing requires emergency care.

Dr. Haas, in conjunction with other specialists, can test for MG using a number of methods, including:

  • blood testing, to look for abnormal antibodies;
  • neurological examination of your physical condition and mental skills;
  • nerve conduction testing and single-fiber electromyography, which test the electrical activity in your muscles; and
  • edrophonium (tensilon) injection testing, to look for immediate, temporary improvement in your muscle strength.

There is no known cure for MG, but if you seek treatment early when you first experience symptoms, you can manage the condition successfully. There are a number of treatment options to manage your condition, including medication and surgery. You can also receive physical therapy and learn specific coping skills to help improve your daily life. Early detection and treatment of MG is crucial to managing the condition and preventing serious problems with breathing or swallowing, which require emergency care.

Thyroid-Related Ophthalmopathy

The thyroid gland, located in the front of the neck, produces hormones that regulate your body's metabolism (the process by which the body transforms food into energy).
In a small number of people, the thyroid gland produces either excessive hormone, inadequate hormone, or it inadequately regulates thyroid hormones. An overproduction of thyroid hormone is often associated with a condition known as Graves' disease; an underproduction is associated with a condition known as Hashimoto's disease. Atypical regulation of the thyroid hormone can cause problems associated with the structure surrounding the eye and the area within the orbit, and it also can cause subsequent vision problems.

Some eye problems associated with the disease are:

  • Eye protrusion: This occurs when the muscles around the eyes swell, which pushes the eye forward. People with this condition look as if they are staring.
  • Eyelid retraction: The combination of eyelid swelling and eye protrusion sometimes causes the eyelids to retract and reveal the sclera (the white part) of the eye.
  • Dry eye: Because of protrusion and eyelid retraction, the eyes are more exposed to the environment. This causes blurred vision, light sensitivity, dry eye, excessive tearing, irritation, and inflammation.
  • Double vision: Muscle swelling may cause double vision.
  • Eye bags: Eyelid swelling can cause tissue around the eyes to bulge forward.

These problems are treated by non-surgical and surgical methods. Non-surgical methods include taking steroid medications by mouth to control swelling and inflammation, wearing sunglasses to relieve light sensitivity, and applying lubricating ointment to relieve dry eye. Surgical methods include repositioning the eye muscles, removing scarred tissue, and relieving compression on the optic nerve to preserve sight.

Orbital Inflammatory Pseudotumor

Orbital inflammatory pseudotumor is characterized by inflammation within the orbit, or eye socket that mimics symptoms similar to a tumor in the same site. The cause is still unknown.

Orbital inflammatory pseudotumor usually occurs in only one eye. Symptoms may include:

  • red eye;
  • bulging eye;
  • pain;
  • double vision; and
  • blurry or decreased vision.

A CT scan and/or ultrasound of your orbits may be ordered to see if there are any signs of inflammation in the orbits or sclera (the white part of your eye), which is a hallmark sign of the condition. In order to rule out other conditions, other tests and a biopsy of orbital tissues could be necessary.

Orbital inflammatory pseudotumor is usually treated with steroid medications. If further treatment is necessary, radiation therapy is another option. In some cases, treatment may fail to eliminate symptoms. In others, treatment will be effective but the symptoms may return, requiring additional treatments as needed.