Seeing Double? How MS Affects Vision

Blurred vision. Shaky focus. Even seeing two of the same thing.

Visual changes can be one of the earliest or most unsettling symptoms for people with Multiple Sclerosis (MS). These issues often feel like something’s wrong with the eyes themselves—but in many cases, the root of the problem is deeper, within the nervous system.

Let’s break down what causes vision problems in MS, how they show up, and why physio might play a small but helpful role in managing some of the symptoms.

Why Vision Changes Happen in MS

As we've discussed in previous blogposts, in MS the immune system mistakenly targets the myelin coating that protects nerves in the brain and spinal cord. When this coating is damaged—known as demyelination—messages can’t travel as smoothly through the nervous system.

When this damage affects areas of the brain responsible for vision, or the nerves that control eye movements, visual symptoms can follow. This doesn’t mean everyone with MS will experience vision problems, but they’re common enough to be worth discussing.

Common Visual Symptoms in MS

1. Optic Neuritis

This is one of the hallmark visual issues in MS. It occurs when the optic nerve—the nerve connecting your eye to your brain—becomes inflamed. It can affect one or both eyes.

What it feels like:

• Blurred or dim vision

• Washed-out colours

• Eye pain, especially with movement

• Central vision loss or blind spots

It's important to have this assessed early, as it may be the first sign of MS or a sign of relapse. While most cases improve, some residual deficits (e.g., mild color distortion or reduced contrast sensitivity) may persist. 

2. Diplopia (Double Vision)

Double vision happens when the muscles that control the eyes aren’t working in sync due to nerve damage.

What it feels like:

• Seeing two overlapping images

• Difficulty with depth perception

• Worse when tired or focusing on close-up tasks

Diplopia can be temporary or persistent and often flares during periods of fatigue, illness, or relapse.

3. Nystagmus

This is involuntary, rapid eye movement—usually side-to-side or up-and-down.

What it feels like:

• Unsteady or shaky vision

• Dizziness or nausea

• Difficulty tracking moving objects

It’s often a sign that MS has affected areas of the brain responsible for balance and coordination, particularly the cerebellum or brainstem.

4. Blurry or Slowed Visual Processing

Some people with MS experience generalised blurry vision or feel like their eyes “can’t keep up.” This might be tied to fatigue, brain fog, or slower visual processing due to cognitive changes.

Visual symptoms often worsen with heat, stress, or tiredness—especially during a flare. This doesn’t necessarily mean permanent worsening, but it’s still worth noting patterns and pacing yourself accordingly.

When to See Someone About It

If you notice any visual changes—especially sudden or worsening symptoms—it’s crucial to speak to a GP, neurologist, or optometrist.

Some symptoms may indicate a relapse or a separate vision issue altogether. Early management can often reduce long-term impacts.

Your doctor or optometrist may:

• Prescribe medications (e.g. steroids to reduce inflammation)

• Recommend special glasses (e.g. prism lenses for diplopia)

• Refer you to a neuro-ophthalmologist for further review

Even if symptoms seem mild, they can affect your safety (e.g. driving, walking on uneven ground) or independence. So don’t dismiss them.

Can Physio Help? Maybe, but Indirectly

While physiotherapists don’t treat the eyes directly, we do work with the nervous system. And when vision changes affect your balance, walking, or confidence, physio can play a supportive role.

Here’s how:

1. Vestibular Training

Your inner ear plays a major role in balance. When vision becomes unreliable, strengthening the vestibular system (through exercises like head turns, visual tracking, and standing balance tasks) can help your body compensate.

2. Proprioceptive Practice

Proprioception is your sense of body position. We use it constantly to stay upright and stable. Enhancing this system through physio can reduce your reliance on vision for balance—especially helpful if you have nystagmus or blurry vision.

3. Coordination and Core Stability

Visual issues can make movement feel more uncertain or clumsy. Balance and movement strategies can reduce falls risk, improve confidence, and support safer movement even when vision isn’t perfect.

Want Support with Balance, Vision, or Dizziness?

Our MS PhysiKit includes:

• A Dizziness & Vestibular Toolkit, with simple assessments and home-based vestibular exercises

• A Balance Toolkit, helping you improve proprioception and core stability

• Easy-to-follow strategies to support safer movement and daily confidence

These aren’t substitutes for medical care—but they’re designed to support you, especially when symptoms linger between appointments.

🔗 If you're experiencing balance or dizziness challenges, our MS PhysiKit may help

 _References

_{Dhanapalaratnam, R., Markoulli, M., & Krishnan, A. V. (2022). Disorders of vision in multiple sclerosis. Clinical and Experimental Optometry, 105(1), 3-12. https://doi.org/10.1080/08164622.2021.1947745}