Multiple Sclerosis and eye twitching


Ever found your eye starts to twitch when you’ve been staring at your computer for umpteen hours? It’s really common (if not annoying) for our eyelids to get a little jittery when we’re tired. Eye twitching can, however, also be a chronic issue faced by people living with multiple sclerosis.

Known as ‘myoclonus’, sudden and involuntary eye twitching can be a common early symptom of the condition. 

MS is an autoimmune disease in which the immune system attacks the protective layer that surrounds and protects nerve fibres. Those damaged areas are called lesions. 

These lesions can affect different parts of the central nervous system, including the brain and optic nerves - which is why vision problems are a common early sign of MS.

MS-related myoclonus happens when a nerve cell misfires, sending the wrong signal to the eye muscles. That can happen as a result of demyelinating lesions. 

What causes it?

Despite the fact that most of us will have experienced some kind of eye twitch before, in people with MS, there’s not one root cause. In fact, there are four main eye conditions that tend to affect many people with MS and eye twitching is just one symptom. 

Nystagmus

If you’ve ever experienced the sensation of your eyes making uncontrollable circular, horizontal or vertical movements, you may have had nystagmus. It makes it impossible to look at something steadily.

That may sound really alarming - after all, we rely on steady vision for coordination and balance - but it’s a relatively common symptom of MS. And while you may not notice or feel it happening if you have it mildly, other people may see it.

Nystagmus tends to be caused by one of two things. Nerve damage to the cerebellum or brainstem - regions in the brain that control balance, muscle movements and vision - may trigger involuntary eye movement. It might also result from damage to the optic nerve which then results in visual information being incorrectly interpreted. 

If left untreated, nystagmus can make you feel dizzy or nauseous - to say nothing of putting you at risk from falling.

Treatment

There are a number of treatments your GP or MS team might recommend, including trying drugs like gabapentin or memantine.

Things you can do include:

  • wearing glasses to improve your vision which may in turn slow down eye movements (although this isn’t a cure)
  • applying a handheld vibrating massager to your skull to see if that temporarily dulls the sensation

If you’ve started to nod, shake or hold your head in a particular position to reduce the eye flickers, be sure to massage the neck and shoulders frequently as you may start to experience stiffness and pain. It really is worth talking to your MS team, however, to find a more suitable solution.

Internuclear ophthalmoplegia

Your eyes move from side to side thanks to hard working nerve fibres. When they get damaged, you stop being able to make those horizontal movements even though you can still look up and down. 

It tends to affect younger people with MS and impacts on both eyes. 

Treatment

It’s thought to affect up to 23% of people with MS with most people making a full recovery. If you have an acute case, however, a GP might recommend a course of intravenous steroid therapy.

Optic neuritis

An inflammation of the optic nerve can result in blurred vision, pain and sudden loss of vision (usually in one eye). It can even cause a dark spot in the centre of your vision to appear. According to the MS Trust, optic neuritis is the first MS symptom one in for people with MS notice. 70% of people with MS will experience it at some point.

These blind spots tend to come on suddenly and gets worse over a few days - reaching its peak two weeks after first appearing. After that, it can take up to six weeks to recover (although visionary issues can continue for longer).

Treatment

It tends to clear up on its own but you can take steroids to help reduce the inflammation quicker and to prevent any permanent damage to the nerve. If you’ve not got an MS diagnosis, you may be invited to undergo a range of tests like blood and eye tests as well as MRI scans to check for MS (you can have optic neuritis independently of the condition).

Diplopia - AKA double vision

Having double vision can be alarming and dangerous. Diplopia happens when the muscles that control a particular eye movement weaken and stop working together effectively. The vision in each eye might be fine but the eyes no longer coordinate so you stop getting the vision message from each eye.

People with relapsing remitting MS often experience double vision as part of a relapse. 

Treatment

This gets worse the more tired you are, so it’s important to make sure that you take breaks when necessary and listen to your body. If you drive, make sure that you are fully rested before going behind the wheel and stop as soon as you start to feel any fatigue or eye issues come on.

Your GP may recommend taking a course of steroids, having botox* or surgery to adjust the muscles that control vision to restore the symmetry of your eye position.

Things you can do include:

  • wearing an eye patch over one eye to block out one of the images
  • stick a Fresnel prism onto your glasses. These adjust the way the light enters your eye to help realign the two images

*Did you say botox? Is that really a treatment for MS?

Yep, you read that correctly. Botox injections can be used to treat several symptoms, including bladder spasms, tremors and spasticity.

It works by blocking the electrical message from a nerve to a muscle - causing muscle paralysis, weakness and relaxation. After a few months, it’ll wear off and the damaged nerve ending will start to regrow…sending messages again. When you feel symptoms returning, you can have the injections repeated.

There aren’t many side effects to having botox but as we all know, too much of it can result in total paralysis of certain muscles (as in frown and smile-proof foreheads!). 

Information contained in this Articles page has been written by talkhealth based on available medical evidence. The content however should never be considered a substitute for medical advice. You should always seek medical advice before changing your treatment routine. talkhealth does not endorse any specific products, brands or treatments.

Information written by the talkhealth team

Last revised: 3 June 2020
Next review: 3 September 2020