Vertigo and Eye Movements in Multiple Sclerosis

The defective eye movement jerking in MS or in other conditions involving vertigo or perceived visual field jitter is called nystagmus. These jerks seen by the physician on examination are imperfect attempts by the nervous system to correct an abnormal situation. Our eyes tend to move together in a given direction (conjugately). In MS, if connections to nerves that will eventually stimulate eye muscles to move smoothly or direct gaze are inflamed, limitations in eye movement and nystagmus can result. One classic example in MS is a brain stem plaque that can limit the movement towards the midline of one eye and nystagmus with eye movement away from the midline in the other eye. This is called Internuclear Ophthalmoplegia (INO) due to a Medial Longitudinal Fasciculus (MLF) lesion. With conjugate movements of the eyes to the left, a right INO would prevent the right eye from moving to the center and would reveal the left eye jerking when looking to the left.

Although not typically associated with vertigo, INO symptoms can include oscillopsia (moving vision), particularly with gaze in a certain direction or double vision (diplopia) that resolves when one eye is covered. Nystagmus may also not be associated with symptoms despite being noted on examination.

To summarize: If you are dizzy, your problem may be due to an MS attack on the nerves in the brain stem that connect to the inner ear. Your doctor, on evaluating this condition, may find that you have abnormal involuntary jerking eye movements called nystagmus in one or both eyes. Along with dizziness or vertigo, double vision, moving vision, gait imbalance, nausea, vomiting, hearing loss or tinnitus can complicate the presentation.