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Ocular Motor Manifestations of Multiple Sclerosis

Nerrant, Elodie MD; Tilikete, Caroline MD, PhD

Section Editor(s): Biousse, Valerie MD; Galetta, Steven MD

doi: 10.1097/WNO.0000000000000507
State-of-the-Art Review

Background: Multiple sclerosis (MS) is a demyelinating disease of the central nervous system leading to disability, especially in young patients. Acute or chronic lesions of MS within the brainstem and the cerebellum frequently result in ocular motor disorders.

Evidence Acquisition: This review encompasses the spectrum of ocular motor disorders in patients with MS emphasizing prevalence, examination findings, diagnostic features, functional consequences, classification of MS course, and management of these disturbances of ocular motility.

Results: Ocular motor manifestations of MS can occur acutely in relapse or chronically, the latter as a consequence of previous relapses or as a chronic course of the disease. The most frequent and specific acute ocular motor manifestation is uni- or bilateral internuclear ophthalmoplegia (INO). The most frequent chronic manifestations include INO and cerebellar ocular motor disorders such as gaze-evoked nystagmus, saccadic hypermetria, and lack of vestibulo-ocular reflex inhibition. The most disabling syndrome is pendular nystagmus.

Conclusions: The high prevalence of ocular motor manifestations emphasizes the importance of neuro-ophthalmological examination among patients with MS. Because chronic manifestations may cause minimal or no symptoms, a systematic investigation of the most common manifestations should be performed in daily practice. Appropriate treatment may improve visual outcome in some of these ocular motor disorders.

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Hospices Civils de Lyon (EN, CT), Neuro-Ophthalmology and Neurology D, Hôpital Neurologique Pierre Wertheimer, Bron, France; Lyon I University (EN, CT), Lyon Est Medical School, Lyon, France; and CRNL (CT), INSERM U1028, CNRS UMR5292, ImpAct Team, Bron, France.

Address correspondence to Caroline Tilikete, MD, INSERM U1028, CNRS UMR5292, ImpAct Team, 16, Avenue Doyen Lépine, 69676 Bron Cedex, France; E-mail:

The authors report no conflicts of interest.

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© 2017 by North American Neuro-Ophthalmology Society