Neuro-ophthalmological involvement in multiple sclerosis (MS) is common, and often the initial manifestation. Increased understanding of both visual and ocular motor system demyelination has contributed significantly to advances in our knowledge of the prognosis, treatment, and pathogenesis of MS. Moreover, advances in neuroradiological techniques have improved correlation of brain demyelinating lesion burden with clinical disease activity, and their application to both optic nerve and ocular motility disorders has contributed to improved lesion localization, and prediction of disease course.
Approximately one-fifth of patients ultimately diagnosed with MS have initially presented with acute visual loss secondary to optic neuritis, and up to two-thirds of MS patients have an episode of acute optic neuritis at some stage during the course of their disease (Rodriguez et al. 1995). The propensity of MS to affect the optic nerves is further evidenced by the frequent occurrence of subclinical optic neuropathy, with eventual development of bilateral
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