BMJ  2006;332:668 (18 March), doi:10.1136/bmj.332.7542.668-b

Letter

Diagnosis and treatment of multiple sclerosis

Ocular manifestations of multiple sclerosis

EDITOR—Murray reviewed the diagnosis and treatment of multiple sclerosis.¹ Ocular manifestations are sometimes the first sign of the disease, including optic neuritis, internuclear ophthalmoplegia, ocular motor cranial nerve palsies, trigeminal and facial nerve palsies, nystagmus, pars planitis, and retinal periphlebitis.² These conditions may predict additional demyelinating events.

The optic neuritis treatment trial is a randomised 15 centre trial of 457 patients to assess the effects of corticosteroids in optic neuritis.^{3 4} The results showed that intravenous methylprednisolone hastened the recovery of visual function after optic neuritis without significantly improving the long term final visual acuity. The trial also showed that while intravenous steroids reduced the incidence of symptomatic multiple sclerosis, oral steroids were associated with an increased recurrence of optic neuritis.

The treatment of intermediate uveitis due to multiple sclerosis is indicated when the visual acuity is 6/12 or less due to cystoid macular oedema. This includes systemic and posterior subTenon steroids, cryotherapy, and pars plana vitrectomy.⁵

Symptomatic patients with longstanding ocular motility disorders and ocular cranial nerve palsies may benefit from prisms or corrective surgery on extraocular muscles.

Stirling Royal Infirmary, Stirling FK8 2AU seham_tm{at}hotmail.com

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Competing interests: None declared.

References

1. Murray TJ. Diagnosis and treatment of multiple sclerosis. BMJ 2006;332: 525-7. (4 March.)[Free Full Text]
2. Chen L, Gordon LK. Ocular manifestations of multiple sclerosis. Curr Opin Ophthalmol 2005;16: 315-20.[Medline]
3. Beck RW, Cleary PA, Anderson MM, et al. A randomized, controlled trial of corticosteroids in the treatment of acute optic neuritis. N Engl J Med 1992;326: 581-8.[Abstract]
4. Beck RW, Cleary PA, Trobe JD, Kaufman DI, Kupersmith MJ, Paty DW, et al. The effect of corticosteroids for acute optic neuritis on the subsequent development of multiple sclerosis. N Engl J Med 1993;329: 1764-9.[Abstract/Free Full Text]
5. Kanski JJ. Clinical ophthalmology, a systematic approach. 5th ed. Butterworth-Heinemann, 2003.

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Relevant Article

Diagnosis and treatment of multiple sclerosis

T J Murray
BMJ 2006 332: 525-527. [Extract] [Full Text] [PDF]