Abstract
Purpose :
While optic neuritis is the most frequent ocular manifestation of multiple sclerosis (MS), the relative frequency of internuclear ophthalmoplegia (INO), nystagmus, saccadic intrusions, cranial nerve palsy and others are largely unknown in population-based studies. Determining the relative frequency of MS-related ocular conditions is important to help guide screening for and treatment of ocular disorders in MS patients.
Methods :
We analyzed all prevalent MS patients in a well-defined population (Olmsted County, MN) on December 31, 2011 who had onset of MS between 1998 and 2011. Records were obtained through the medical records linkage system of the Rochester Epidemiology Project, which captures all patient–physician encounters in Olmsted County (MN).
Results :
Of the 116 patients with MS who had symptom onset between 1998 and 2011, the majority were female patients (66%). The mean age was 37.1 years (SD 11.7). Overall, 51% of MS patients (59/116) had MS related ocular conditions during their disease course. At MS onset, visual symptoms were the presenting MS symptoms in 28% of cases (33/116): 6/33 patients (18%) had only non-optic neuritis visual disorder, 21 (64%) had only optic neuritis, and 6 (18%) had a combination of optic neuritis and non-optic neuritis visual disorder. Optic neuritis is the leading ocular condition experienced by MS patients (43/116), followed by INO (18/116), nystagmus (15/116), saccadic intrusion (3/116), cranial nerve palsy (2/116), skew deviation (2/116), and visual deficit due to retrochiasmal lesion (1/116). Nine of 18 (50%) patients with INO presented with INO at onset of MS while the 9/18 (50%) acquired INO after the diagnosis of MS with a mean time of 5.1 years (SD 5.1) after MS symptom onset. 17% (3/18) of patients had misalignment, one of whom had large angle exotropia requiring strabismus surgery, and the rest only manifested as slowed saccades. 44% of patients with INO were asymptomatic. Of the patients with nystagmus, 12/15 had gaze-evoked, 2/15 had torsional and 1/15 had upbeat nystagmus. Both patients with cranial nerve palsy had cranial nerve VI palsy.
Conclusions :
While optic neuritis is the most common MS-related ocular condition, many other ocular symptoms can be present. INO being the second most common ocular finding can be subtle and asymptomatic but still play an important role in clinching the diagnosis of MS.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.