Why is my vision shaky?

Multiple Sclerosis: The Eyes Have it

If fatigue can be listed as the most prevalent symptom of multiple sclerosis, then surely vision issues must be very high on the list of presented symptoms at diagnosis.

When we think of MS “vision issues” most of us jump to optic neuritis (ON): inflammation or demyelination of the optic nerve. While that makes sense as it’s the MS vision problem most talked about, ON isn’t the limit of what MS can do to our sight.

Many of our (ok, I’m speaking as the guy who probably had symptoms back into my high school years) symptoms go ignored by us or are misdiagnosed by the medical profession. Wake up in the morning with “acute blurring, graying (change in color saturation), or loss of vision, most often in only one eye” or pain which “can be of several types — dull and aching, pressure-like, or sharp and piercing” and there is no ignoring.

I’ve heard from many that it was their eye doctor who referred them to see a neurologist for an MS consult, not their primary care providers.

Other vision problems are associated with MS, one of which I experienced over this past weekend for the first time.

The uncontrolled horizontal or vertical eye movement is called nystagmus. Nystagmus can present itself as a “shaking” of our field of vision, which can look like the inability to focus. Someone looking at your eyes can often see them quaking as you try to focus on a stationary object in space. One who hasn’t experienced nystagmus can only imagine how frightening — and dangerous — that can be to live with.

I did not have my eyes quaking in their sockets. I experienced diplopia or “double vision” which is thought to be caused by misguided muscles rather than the optic nerve itself.

This makes sense if I think about how the muscles in my hands, arm, leg and other parts of my body are affected. If I cannot hold my arm steady for my tremor of intent, I can totally understand that it could happen to my eyes, which need a much more fine control to stay on track.

My double vision episode lasted but a couple of hours and, as recommended, eased with rest and with closing my eyes for a short while. I’ll not say that I napped; my brain was far too aware of what might be happening to me to allow for real rest. I do, however, feel like I’ve been walking gingerly through the first part of this week in response.

It’s as if something new has jumped out of a dark corner of this haunted hallway we tread and I have responded by walking on tipped toes with my body crouched and arms half-cocked in anticipation of the next beastie around the next misty bend.

This symptom caught me off guard and it frightened me.

We don’t often share symptoms of vision in these pages. Maybe it’s time to have a go of it…

Wishing you and your family the best of health.



Don’t forget that you can also follow me via my Life With MS Facebook page and on Twitter. And check out the new blog I’m doing for the Multiple Sclerosis Society of the United Kingdom, A Yank’s Life With MS.

Eye Movement Disorders

When you look at an object, you’re using several muscles to move both eyes to focus on it. If you have a problem with the muscles, the eyes don’t work properly.


Most of us are fortunate because our eyes started to work as a team very early in infancy and have continued to work together ever since. We are able to focus each eye on whatever we look at, regardless of the direction, and our brain combines the picture or image from each eye into the mental picture we actually see in three dimensions.

About two percent of every 100 children are not as fortunate. For a variety of reasons, their eyes do not work as a team. Both eyes are not directed or focused at the same object. This condition is called “strabismus.”

The child with strabismus rarely complains. In most cases, it is the appearance of the eye that first catches the parent’s attention. A child should be examined by an ophthalmologist whenever the eyes appear not to be working together.

There are three basic kinds of strabismus: esotropia, exotropia and hypertropia, depending on which direction the eyes are deviated.


The most common type of strabismus is esotropia, which occurs when either one or both eyes turn in toward the nose. Some children are born with this condition. More frequently, it starts at about age 2 1/2. When esotropia occurs in these older children, eyeglasses can often help to treat the condition by correcting the child’s vision for farsightedness or hyperopia. This can reduce or eliminate the crossing by changing the child’s need for excessive focusing.

In some children a broad nasal bridge or an extra skin fold give the false appearance of esotropia. This condition is known as pseudoesotropia.


Exotropia is the second most common kind of strabismus. In this condition, one or both eyes turn out. It usually starts at age two or three. In the beginning, the eye may drift out only for a few seconds when the child is tired or ill. It typically occurs when the child looks far away. Closing one eye in bright sunlight when playing outside is also a common early sign.


Hypertropia is the least common type of strabismus. In this condition, one eye is higher than the other. As a result, the child often tilts or cocks his or her head to one side to get rid of the double vision that this problem frequently causes.

Strabismus in Adults

Although strabismus is much more common in children, many adults have strabismus, either since childhood or developed in adult life. A special section of the Wills Eye Pediatric and Ocular Genetics Service, called Adult Motility, is set aside for the management of this group of patients. No person is ever too old to have treatment for stabismus.

Strabismus Treatment

Treatment of strabismus may involve patching, eyeglasses, surgery or some combination of these therapies. Strabismus surgery is a delicate procedure performed on the muscles that attach to the outside of the eyeball. There are six muscles attached to each eyeball that move it around.

Eye muscle surgery consists of weakening or strengthening one or more of these muscles in one or both eyes, depending on the type of strabismus. This procedure is done with the child asleep under general anesthesia. Usually, the child comes to the hospital the morning of the surgery and is discharged the same day, several hours after surgery. The eyes are moderately red for a week following the procedure. Once the child leaves the hospital, there is minimal discomfort. In most cases he or she may return to his or her usual activities at home. However, it should be noted that sometimes more than one surgery is required.


Amblyopia (lazy eye) is another frequent condition, occurring in about three or four of every 100 children. When a child is born with normal eyes, he or she has the potential for good vision in both eyes, but must learn to see with each of them. If for some reason, the child prefers to use one eye more than the other, the preferred eye learns to see well but the other suffers from lack of use. It does not learn to see as well, even with glasses. The non-preferred eye is said to be lazy or have amblyopia.

One of the common causes for lazy eye is strabismus. When the child’s eyes are pointed in different directions, the child has to use one eye at a time to avoid seeing double. If he or she uses one eye more than the other, the other eye becomes lazy.

Children without strabismus can also develop a lazy eye. Even though their eyes are straight, one eye is preferred more than the other. This non-preferred eye becomes lazy and does not learn to see.

Amblyopia does not bother the child because there are no symptoms. It is found only by checking the vision in each eye. This can be done fairly accurately in any child three years or older. For this reason, all children should have their vision tested by age four.

The treatment for amblyopia involves forcing the lazy eye to be used more often. Usually this is accomplished by patching the preferred, or good eye. This may have to be continued for several months until each eye sees equally well. Fortunately, it is usually successful in restoring good sight. Sometimes the patching must be continued intermittently until age nine. If the lazy eye is out of focus, eyeglasses may be required, in addition to patching the good eye, to obtain the best sight.

Eye Movement in Children

Many children enter the world with less than 100 percent of their expected visual capacity, a deficiency that is not always obvious to
parents or medical professionals. One sign of possible eye problems, however, is eye movement. Eye movements tell a lot about vision, even if a child is pre-verbal. How well a child follows faces or large objects is a clue to his or her visual abilities. Another indication of a possible disorder is unusual jiggling of a child’s eye(s), called nystagmus. These eye movements can be constant or intermittent. They can be horizontal, vertical, oblique, torsional (circular) or combinations of the above. Thus, the study of eye movement can provide important information regarding sight.

Eye Movement Testing

The testing is conducted with sophisticated computer technology and video recording equipment. The specially designed tests can record eye movements in thousandths of a second and fractions of a degree that show the slightest irregularity and patterns of the jiggling.

Eye Movement Analysis

By using electro-oculograms, where small electrodes are placed on the skin around an infants eyes, eye movements of children under one year of age can be recorded. (This test is not painful or harmful to the child.) Patients are routinely videotaped for further analysis. The general behavior of the child at the time of the test is also assessed. This system has enabled our researchers to describe and document the different types of eye movements in infants — something that no other center had previously been able to do.

For more accurate recordings of adults and older children, special contact lenses containing fine hairline wires are placed on the eyes and then connected to recording devices. A computer-controlled target is directed onto a screen so that precise areas of the retina can be stimulated, even in randomly moving eyes. The special contact lenses provide horizontal, vertical or torsional recordings with a precision and range not usually available, affording measurements on eyes that cannot accurately track a target.

Vision Testing

The vision of infants, preverbal children and certain adults is measured by a spatial frequency sweep VEP (visually evoked potential). During this test a patient watches a television screen filled with lines, the sizes of which are changed by computer. As the lines are reversed, the brain waves that are generated by vision are recorded until the widths of the lines are too small to be seen. After analyzing these waves, the computer provides highly accurate estimates of the patient’s visual acuity.

Another type of VEP uses flashes instead of lines. This test is particularly helpful in determining which nystagmus patients have albinotic traits – those that occur in albino children — and whether the child has any potential for binocular vision.

Because children are always growing and developing, the Foerderer Center provides ongoing testing as the child’s condition evolves. Children with eye movement disorders are monitored closely with repeat testing while they are young.

Genetic Testing

Genetic testing and counseling is available to the parents of children with eye movement disorders that are linked to heredity. The Foerderer Center staff take detailed family histories in these cases to provide for the genetics counseling and to further study family members. This information is not only helpful to parents but also to the research of
these conditions.


Nystagmus is a condition where the eyes make repetitive movements. The eyes can jerk exclusively in one direction, or make back and forth movements. With nystagmus, the eye can look jittery and can affect both eyes or just one eye.

How Visual Symptoms of MS Affect Me

Multiple Sclerosis (MS) symptoms related to vision are probably some of the most common symptoms experienced by people with MS. Optic neuritis (damage to the optic nerves which most commonly causes blurry vision) is in fact a common first symptom that often leads to an MS diagnosis (or at least the start of the diagnostic process). This symptom in particular usually responds pretty well to steroid treatments such as oral Prednisone or IV Methylprednisolone (Solu-Medrol) which tends to result in the optic neuritis completely or mostly clearing up.

Visual symptoms are a daily challenge

But over time the damage that cannot be reversed starts to accumulate making these visual symptoms a daily challenge even with glasses/contacts. And most people with MS eventually develop (or even start their MS battle with) other visual symptoms than optic neuritis which all can be debilitating in their own ways. I myself live every day with an assortment of symptoms that affect my vision so today I would like to go over them and talk about how they impact my life and some of the things I do to overcome them (or at least cope with them) the best I can.

Optic neuritis doesn’t just cause blurry vision

As I mentioned, one of the most common presenting symptoms of MS is optic neuritis and for me, that symptom was among the many symptoms that popped up out of nowhere in the weeks leading up to my diagnosis. In my case, it was just an overall blurriness that was (at the time) pretty much completely resolved with steroids and a pair of glasses but optic neuritis doesn’t always just cause blurry vision. For some people, it can also cause minor (or complete) color blindness, pain “behind” the eye, flashing lights (even when the eyes are closed), or even a complete (or partial) loss of vision in the affected eye.

My experience with optic neuritis

I say “the eye” and not “the eyes” because optic neuritis usually affects one eye at a time. As is the course of the disease, this symptom (for me) has only gotten worse over time as each attack (AKA flare-up or relapse) has left me with a small amount of permanent damage (long-term disability) so in the time since my diagnosis, my vision without my glasses has gotten progressively worse. Luckily, I have never experienced the pain that many people get but I have had nights full of bright flashes of lights while I lied in bed trying to fall asleep as well as short periods of time where the vision in one eye seemed “desaturated” like all the colors around me had been dulled out.

Developing a blind spot

Now I also mentioned that optic neuritis can cause a complete or partial loss of vision. After a while I developed a small blind spot in my left peripheral which, now that I think about it, I am honestly not 100% sure is due to optic neuritis or not. I think I just have always assumed that it is so I never really looked too deeply into it. At first I really only noticed this while I was driving; cars in the oncoming lane to my left would basically vanish for a split second when they would pass through that small spot.

A visual field test

When I told my optometrist about this he did a “visual field test” which basically involves you covering one eye at a time and staring at a mark in the center of a large, concave, plastic dome thing that makes it look like you are in a bright, empty, white room. Throughout the test tiny dots of light randomly appear across the dome (which completely covers your peripheral so that you can’t see outside of it) and every time you see one you press a button indicating to the machine where you can and can’t see. This confirmed that there was a spot in my left peripheral that was basically completely blind because I could not see any of the small dots of light that appeared in that area of my vision. I actually don’t drive anymore so I really don’t notice this unless something moves across my line of sight and I don’t stop looking at whatever I am looking at.

My most debilitating MS symptoms

Now onto what I would say is one of my most debilitating MS symptoms of all; Oscillopsia/nystagmus. At this point we are crossing into a territory where this visual symptom of mine is closely tied to vestibular and maybe even cognitive symptoms that I deal with so I will try to keep the focus on the visual aspect but the line between these symptoms is kind of blurry so it may be difficult (blurry…no pun was intended, but now that I see it, I will just say that it was me trying to be clever, haha… now that I see it); ok, anyway, oscillopsia. Oscillopsia is a really weird symptom that I have never felt able to adequately explain to people.

What is nystagmus?

So first I need to make sure we all know what a symptom called nystagmus is. There are quite a few different types of nystagmus as well as different causes but right now that doesn’t really matter so long as you get what it basically is. Go on YouTube and look up an actor by the name of Pruitt Taylor Vince, in fact, just put in his name and nystagmus in the search bar and watch a few clips of him while paying close attention to his eyes. You will notice that they are constantly shaking left and right. That uncontrollable eye movement is called nystagmus and I am sure you could imagine how navigating your daily life while dealing with that may be. I myself get a minor nystagmus when I look to my far left but I usually don’t have any reason to do that so it’s no big deal to me but here is where it gets debilitating.

What is oscillopsia?

Oscillopsia is a type of nystagmus where the world appears to be moving even when you are perfectly still (including your eyes). But now we are getting pretty close to that line between visual and vestibular symptoms because it doesn’t just LOOK like the world is moving but it also FEELS like it is. I guess it is similar to the sensation of vertigo and sometimes it is so severe (it gets worse with head movement or an excess of visual stimuli) that I have to sit down or else I will fall. When this happens, you can usually see my eyes shaking left and right like Pruitt Taylor Vince’s but sometimes it actually feels worse when it is not all crazy like vertigo because I will be sitting there just staring at something like the texture in the ceiling and it will look like it is moving when I know it isn’t.

Everything looks like it’s moving

No matter how hard I focus my eyes, there is always a subtle movement to it and while I have learned to live with it (mostly), I still have times where walking is really difficult just because everything looks like it is moving and also feels like I am trying to walk heel to toe on a large, swaying boat. It really screws with my brain (well, my mind) because for me the subtle movement can make it more difficult to convince my brain that I am actually standing still and that I don’t have to move in a way that would keep me balanced if things were actually doing what they appear to be doing. My brain is receiving a signal from my vestibular system that is telling me to do one thing to stay balanced while my brain is also receiving a signal from my eyes that is telling me to do something completely different!

My story with driving

So when it comes to driving here is my story. In January of 2015 I started noticing this weird symptom creep into my life but at the time it was minor enough that I was sure I could deal with it and not let it get in the way of me functioning. However, it very quickly got worse to the point where I was starting to question my ability to safely drive. In February of that same year, I got in the car, took a deep breath and told myself that I could do this, it was no big deal. I was driving towards the exit of our neighborhood, and before I could leave I totally jumped the curb. So I stopped and just sat there with my hands on the wheel. I can’t drive. Not like this. So I turned around and parked the car and with the exception of a few times where I wanted to see if anything had changed while I sat in the driver’s seat, I have not driven.

Deciding for myself that driving wasn’t safe

It sucks, and for so long, I refused to accept that I would probably never drive again, but at this point, that is a reality I have come to terms with. No one took my license away, in fact, if I went to the DMV right now I would pass all their vision tests with no problem because they simply do not check for any of the visual issues I have. A flaw in the system if you ask me. Anyway, I feel better knowing I have my license and could drive if I wanted to, but I am the one who is deciding for myself that it is just not safe for me to drive anymore. It’s not safe for me and not for everyone else on the road. I refuse to be responsible for the death of someone else simply because I wanted to be able to drive myself to the store or grab a coffee. Part of being a responsible adult is being able to recognize that just because you can do something (legally) does not mean you should. Deciding that I was done driving (when I have always loved everything about it) was not an easy decision but it was the right decision and I hope that others in similar situations to mine can do the same thing.

Nystagmus: Involuntary eye movements


By Burt Dubow, OD

Nystagmus is the term used to describe involuntary repetitive eye movements that make it impossible for a person to keep their eyes fixed on any given object.

There are two basic types of nystagmus:

  1. Jerk nystagmus — the eyes make a very quick movement in one direction, followed by a slower movement in the opposite direction.
  2. Pendular nystagmus — the eye movements are of equal velocity in each direction.

Nystagmus is usually infantile, meaning people have it from a very early age. Experts say that about one child out of every several thousand has nystagmus.

Nystagmus classifications

Different kinds of nystagmus include:

  • Congenital nystagmus
  • Manifest nystagmus
  • Latent nystagmus
  • Manifest-latent nystagmus
  • Acquired nystagmus

Congenital nystagmus is present at birth. With this condition, your eyes move together as they oscillate (swing like a pendulum). Most other types of infantile nystagmus are also classified as forms of strabismus, which means the eyes don’t necessarily work together at all times.

Manifest nystagmus is present at all times, whereas latent nystagmus occurs only when one eye is covered.

Manifest-latent nystagmus is continually present, but worsens when one eye is covered.

Acquired nystagmus can be caused by a disease (multiple sclerosis, brain tumor, diabetic neuropathy), an accident (head injury), or a neurological problem (side effect of a medication, for example).

Hyperventilation, a flashing light in front of one eye, nicotine and even vibrations have been known to cause nystagmus in rare cases.

Some types of acquired nystagmus can be treated with medications or surgeries.

Nystagmus causes, symptoms and challenges

As mentioned above, most people with nystagmus are born with the condition or develop it early in life. Unless induced by trauma or disease, nystagmus almost always is caused by neurological problems.

Two other classifications of nystagmus are:

  • Optokinetic (eye related)
  • Vestibular (inner ear related)

People with inner ear problems can develop jerk nystagmus. Because of the motion of the eyes, people with this condition can develop nausea and vertigo. This type of nystagmus, usually temporary, also can occur in people with Meniere’s disease (an inner ear disorder) or when water settles into one ear. Taking a decongestant sometimes can clear up this type of acquired nystagmus.

All forms of nystagmus are involuntary, meaning people with the condition cannot control their eyes. Sometimes, infantile nystagmus improves slightly as a person reaches adulthood; however, it also can worsen with tiredness and stress.

Having nystagmus affects both vision and self-concept. Most people with nystagmus have some sort of vision limitations because the eyes continually sweep over what they are viewing, making it impossible to obtain a clear image.

Some people with nystagmus have so many vision problems that they can be considered legally blind.

If you have nystagmus, not only is your appearance affected, but you literally see in a way that is different from people who don’t have the condition. Your eyes are in constant motion.

To see better, you may need to turn your head and lock your eyes into what’s called the “null point.” This is a certain head angle that makes the eyes move the least, stabilizing the image for better vision.

When you have nystagmus, you must deal with the personal and social consequences of this difference.

Nystagmus can affect nearly every aspect of your life, including how you relate to other people, your educational and work opportunities and your self-image.

Counseling may be helpful as you face the social and personal challenges often associated with nystagmus.

Can nystagmus be treated?

Several medical and surgical treatments that sometimes help people with nystagmus are available. Surgery usually reduces the null positions, lessening head tilt and improving cosmetic appearance.

Drugs such as Botox or Baclofen can reduce some nystagmic movements, although results are usually temporary.

Some people with nystagmus benefit from biofeedback training.

If you have nystagmus, make sure you undergo regular eye exams so you can be monitored for both health and vision issues.

Both eyeglasses and contact lenses can help people with nystagmus see better, but I have found contact lenses to be the superior alternative for many with nystagmus. With glasses, the eyes sweep back and forth over the lens centers and vision is not as clear. With contacts, however, the lens centers move with the eyes.

Helping children with nystagmus

Usually, nystagmus is discovered at a very young age. Parents and caretakers, here’s how you can help a child who has nystagmus:

  • Find an eye doctor you trust who understands and treats nystagmus.
  • Make sure your child’s glasses or contact lenses are always up-to-date and that vision is corrected to the maximum level possible.
  • Help your child’s teachers understand the basics of nystagmus, including how the condition affects ability to see, learn and interact with other children.
  • Develop a comfort level with explaining nystagmus to family, friends and others who notice your child’s eyes swinging back and forth. Keep your explanation short, to-the-point and positive.
  • Don’t lower your expectations for your child. Most people with nystagmus can see, learn and interact well enough to lead very normal lives.
  • Be positive. Nystagmus, while a visible “disability,” is not the end of the world. As they grow up, children with nystagmus need help in understanding why their eyes are different. Reassure children that nystagmus won’t stop them from being normal kids and normal adults. — Dr. Dubow

Page updated April 2019

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What causes blurred vision and a headache?

Share on PinterestA headache with blurred vision can be a symptom of migraine.

A wide range of medical conditions can cause headaches, and dozens of conditions may cause blurred vision.

However, doctors associate far fewer conditions with both blurred vision and headache, especially when they occur at the same time.

Some of the possible conditions that can cause simultaneous headache and blurred vision include:


Migraine affects at least 10 percent of the world’s population. Migraine headaches cause severe throbbing or pulsing pain in a part of the head.

Roughly one-third of those people with migraine also experience visual disturbances, such as blurred vision.

Some of the other symptoms that doctors commonly associate with migraine include:

  • sensitivity to light and sound
  • nausea and vomiting
  • blind spots
  • tunnel vision
  • zigzag lines that move across the field of vision and often shimmer
  • partial or complete temporary loss of vision
  • objects seeming closer or further away than they are
  • seeing dots, stars, squiggles, or flashes of light
  • seeing an aura of light around objects

Visual symptoms of migraine tend to last an hour or less. Most people experience the visual problems before the pain sets in, but they can also occur during the headache itself.

People can typically treat the symptoms of migraine with analgesics, such as ibuprofen and aspirin, or prescription medications, such as sumatriptan or ergotamine drugs.

The sooner someone takes these medications in the course of the migraine, the more effective they usually are.

Low blood sugar

Blood sugar levels naturally rise and fall throughout the day and in between meals.

If someone’s blood sugar levels get too low, typically less than 70 milligrams per deciliter (mg/dL), they become hypoglycemic. Without treatment, hypoglycemia can be very dangerous.

Hypoglycemia can cause headaches and blurred vision when the brain is starved of glucose, which is its primary fuel source.

Other signs and symptoms of low blood sugar levels include:

  • feeling anxious or nervous
  • sweating, clamminess, and chills
  • confusion
  • feeling shaky
  • fast heartbeat
  • dizziness or lightheadedness
  • irritation or impatience
  • pale skin
  • sleepiness
  • clumsiness or coordination problems
  • weakness
  • lack of energy
  • hunger
  • nausea
  • numbness or tingling in the tongue, lips, or cheeks

If someone thinks their blood sugar levels are too low, they may want to consume something with sugar or carbs, such as fruit juice, and check their blood glucose levels if they have an underlying condition such as diabetes.

If blood glucose levels dip below 70 mg/dL, the American Diabetes Association suggest eating 15 grams (g) of carbs, waiting 15 minutes, then retesting glucose levels.

If blood glucose levels are still below 70 mg/dL, the individual can eat another 15-g serving of carbohydrates and repeat the process until levels stabilize.

Once blood glucose levels are back to 70 mg/dL, a person can eat a healthful meal to prevent glucose levels from dropping again.

People whose blood glucose levels go too low may receive a hormone called glucagon. People with conditions that can cause severe hypoglycemia, such as diabetes, may receive a glucagon kit to keep at home. A healthcare professional will teach them how and when to use the kit.


A stroke can occur when a blood clot blocks a vessel carrying blood to the brain. This is called an ischemic stroke. Less commonly, a stroke may happen when a blood vessel in the brain ruptures, which is called a hemorrhagic stroke.

Strokes are responsible for 1 out of every 20 deaths in the United States, or around 140,000 deaths, every year.

Strokes can cause blurred vision in one or both eyes and a sudden, severe headache.

Other symptoms often associated with strokes include sudden:

  • numbness or weakness of the arm, face, or leg, especially on one side of the body
  • confusion
  • difficulty speaking and understanding speech
  • trouble walking, dizziness, and loss of coordination or balance

Without prompt treatment, strokes may cause life-threatening and permanently disabling complications. If a person thinks they or someone around them is having a stroke, they must call the emergency services immediately.

A doctor may give someone who has had an ischemic stroke medication to help break up a clot and improve blood flow to the brain. They may also need to perform surgery to remove the clot.

People who have had a hemorrhagic stroke may require surgery to stop the bleeding in their brain.

Recovery from a stroke can take a long time and will require several forms of therapy. After a stroke, many people also have to take medications to reduce their risk of having another stroke.

Traumatic brain injury

Share on PinterestSome TBI symptoms may take days to appear.

A traumatic brain injury (TBI) is an injury that interferes with normal brain functioning. A jolt, bump, hit, blow, or penetrating object cause most TBIs.

The specific symptoms of a TBI depend on the part of the brain that the injury has affected and the extent of the damage. Although some signs of TBI can show up immediately, others can take days to weeks to appear.

A concussion is one type of TBI that occurs as a result of a blow to the head.

People with mild TBI often experience a headache and blurred vision. Other common signs of mild TBI include:

  • confusion
  • dizziness and lightheadedness
  • sleepiness
  • ringing in the ears
  • a bad taste in the mouth
  • changes in mood or behavior
  • sensitivity to light or sound
  • loss of consciousness for a few seconds to minutes
  • trouble with attention, thinking, memory, or concentration
  • a change in sleep habits
  • nausea and vomiting

People with moderate to severe TBI often experience a headache that continues to worsen and persist. Other signs of a moderate to severe TBI include:

  • slurred speech
  • convulsions or seizures
  • inability to wake up
  • loss of coordination
  • loss of consciousness, lasting minutes to hours
  • persistent vomiting and nausea
  • numbness or tingling in the arms or legs
  • increasing confusion, agitation, or restlessness

Severe TBI can be life-threatening without treatment. The treatment for TBI depends on the extent, location, and severity of the injury.

Mild traumatic brain injuries, such as concussions, may only require monitoring and self-care.

People with mild TBI should temporarily limit doing certain activities that can stress the brain or increase the risk of reinjury, such as computer work or playing sport.

People with moderate to severe TBI need emergency care and may require surgery to prevent further damage to their brain tissues.

Carbon monoxide poisoning

Carbon monoxide is an odorless, colorless, tasteless gas present in the fumes that burning fuel creates.

More than 20,000 people in the U.S. are admitted to the emergency department for accidental exposure to carbon monoxide every year.

When people breathe in carbon monoxide, it binds to hemoglobin, which is the red protein in blood that carries oxygen around the body. When hemoglobin is bound to carbon monoxide, it cannot carry oxygen to organs and tissues.

Carbon monoxide poisoning causes a variety of symptoms as it deprives the body and brain of oxygen. A headache and vision problems, such as blurred vision, are common signs of carbon monoxide poisoning.

Additional symptoms of carbon monoxide poisoning include:

  • dizziness
  • upset stomach and vomiting
  • weakness
  • chest pains
  • confusion
  • flu-like symptoms

People with mild to moderate carbon monoxide poisoning should get themselves away from the poisonous gas and seek immediate medical treatment. A first responder can provide high-flow oxygen through a mask.

Emergency healthcare teams may give people with severe carbon monoxide poisoning 100 percent oxygen through a tube they put directly into the individual’s airway.

Visual Disorders

Visual problems are common among those with MS and are often a first sign of the disease.

Optic neuritis is often the first symptom of MS. This occurs when inflammation and demyelination are present along the optic nerve (the nerve that connects the brain to the eye). A diagnosis of optic neuritis may suggest MS, but does not necessarily indicate that a person has or will develop MS. Symptoms of optic neuritis include the acute onset of any of the following:

  • Decreased vision/blindness in one eye
  • Blurred vision
  • Graying of vision

Rarely are both eyes affected simultaneously with optic neuritis in MS. Pain with eye movement usually accompanies or precedes visual loss, and visual loss tends to worsen over the course of a few days before improving. Almost 55 percent of people with MS will have an episode of optic neuritis (according to WebMD).

Many functions are involved in seeing an object. Two major components needed for effective vision are (1) the ability to correctly image what is seen and (2) the proper coordination of the muscles that surround the eye and control its movements. Either or both of these functions can be affected by MS.

The most common problems are decreased or blurred vision (caused by optic neuritis), double vision (diplopia), and shaking, involuntary movements of the eyes (nystagmus). While optic neuritis results from inflammation and demyelination along the optic nerve, double vision and involuntary eye movements are the result of lesions in the brain stem, a part of the nervous system between the brain and cervical spinal cord.

Inflammation along the optic nerve or in other areas of the brain and spinal cord is thought to be the cause of MS relapses, and if severe enough, is often treated with steroids (described later). However, as with other symptoms, visual problems in MS can also be brought on by fatigue, an increase in temperature, stress, and infection. Managing these symptoms may help to improve any associated visual problems.

Types of Visual Disorders

Full loss of vision, decreased vision, or blurred vision frequently affects only one eye of a person with MS who is experiencing optic neuritis. Colors may appear washed out, and night vision may be particularly difficult. Sensitivity to contrasts in light or the presence of holes (scotomas or “blind spots”) may also occur. Occasionally, optic neuritis will cause pain upon movement of the affected eye.

Diplopia, also known as “double vision,” occurs when the muscles that control a particular eye movement are weakened and not coordinated. Although annoying, double vision usually resolves on its own without medical treatment. When diplopia comes on suddenly, it could indicate an acute attack.

Less common than diplopia, another disorder stemming from muscle weakness and loss of coordination around the eye is nystagmus. This is the uncontrolled side-to-side (horizontal) or up-and-down (vertical) movements of the eye. It can be asymptomatic (causing no visual problems) or severe enough to disturb vision. Objects may appear to jump or move unpredictably as the two eyes no longer coordinate well with each other. Nystagmus can be more of a nuisance than a major problem and is usually temporary.

Some individuals with MS may experience a scotoma, a disorder that causes a blind spot to appear in the center of vision. A different disorder, homonymous hemianopsia, occurs rarely, causing vision to be lost on the right or left visual fields of both eyes.

Treatment of Visual Disorders

Whenever a visual problem arises, an ophthalmologist or neuro-ophthalmologist should be consulted. At times, the doctor may decide that the best treatment is to wait for the inflammation to go down and to see if the visual symptoms disappear on their own, reserving steroid treatment for more severe attacks.

If the symptoms are severe, intravenous steroid treatment may be used to reduce the inflammation and accelerate the recovery process. The same steroid treatment used to treat other types of MS relapses is often effective in shortening the duration of visual problems. These are usually given via intravenous injection (IV) for a few days, but steroids may also be given orally. An example of high dose steroids would be 1,000 mg of Solu-Medrol® (IV methylprednisolone).

Steroids may be administered two ways. As mentioned, a high dose of Solu-Medrol may be given through intravenous injection (IV), and this is often given daily for three to five days during an attack. Deltasone® (oral prednisone), Decadron® (oral dexamethasone), or Medrol® (oral methylprednisone) in a pill form may also be administered orally for several days after IV treatment, or they may be taken alone without an earlier IV treatment. While these corticosteroids may shorten MS attacks and help one to recover more quickly, no convincing evidence has been shown that corticosteroids can affect the long-term course of MS. Acthar® Gel (ACTH given via injection) is another option for treating MS relapses.

Another line of action is through disease-modifying therapies (DMTs). Presently, 10 disease-modifying therapies are FDA-approved for treating the relapsing forms of MS. Several studies have shown that these can reduce the number and severity of attacks, which in turn reduces the development of visual difficulties.

Several non-pharmaceutical options are also available to help cope with visual changes. For instance, an eye patch is sometimes used to treat diplopia (double vision) when necessary, such as when driving or reading. An ophthalmologist may also offer additional ideas or treatments for specific visual symptoms. Examples include using yellow lenses to tone down light for those experiencing a light sensitivity, or prisms in eye glasses to redirect the image. In other instances, a patient may find ways to simply adjust – as by turning the head to allow better alignment of the eyes.

If visual problems persist, an ophthalmologist who specializes in low vision can help provide low-vision devices that include magnification and computer modifications. He or she can also design a variety of helpful strategies for managing daily activities.

Individuals with MS experiencing visual problems are often comforted by the fact that these symptoms are usually temporary. As with other MS symptoms, as noted earlier, please keep in mind that visual problems in MS may also be worsened by stress, fatigue, infection, certain medications, or an increase in temperature. When possible, avoiding situations that could worsen the symptoms of MS will also help to minimize the occurrence of visual issues.

Editor’s note: The details provided in this article are for informational purposes only. Readers are strongly urged to see their physician before making any changes to their treatment regimen.

Reviewed and edited by Robert K. Shin, MD
Associate Professor of Neurology
Associate Professor of Ophthalmology and Visual Sciences
University of Maryland School of Medicine

This content originally appeared in the Winter/Spring 2013 issue of The Motivator.

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Nystagmus (Eye Shaking)

Nystagmus is a medical condition in which the eyes move involuntarily, often shaking back and forth. These involuntary movements may be horizontal, vertical, or sometimes even rotational. The movements may be very subtle, very prominent, or somewhere in between. They can be fast or slow. They usually affect both eyes.

Nystagmus itself is not a diagnosis — it is a sign of another disease. Nystagmus in children is caused by three different categories of disease:

1. Ocular/eye problems

2. Neurologic problems

3. Motor nystagmus

People with nystagmus due to eye problems have abnormal vision, and this decreased visual ability causes the eyes to shake. Ocular causes of nystagmus include childhood cataracts, optic nerve developmental problems, and genetic retinal diseases like Leber congenital amaurosis, albinism, retinitis pigmentosa, or achromatopsia, among others. Pediatric ophthalmologists like Dr. Colburn and Dr. Weed are well-equipped to figure out whether your child’s nystagmus is due to an ocular condition.

Other people have nystagmus due to a neurological problem. There are many different areas within the brain that help control steady, normal eye movements, and problems with each of them can cause different types of nystagmus. Children with neurological nystagmus often have other medical issues as well, such as delays in meeting their childhood milestones. For patients in whom neurological nystagmus is suspected, magnetic resonance imaging (MRI) scans of the brain are often ordered, and the child’s primary care provider may consult a neurologist for assistance.

So what about the final category, motor nystagmus? Patients with this type of nystagmus have had the first two types ruled out. They have otherwise normal eyes, and no neurological problems — their eyes just “like to shake.” Their vision is usually mildly blurry, and this usually remains stable over time.

If you would like to make an appointment for your child to learn more about their nystagmus, please call us at 509-456-0107.

Do stationary objects in your line of sight sometimes appear to be moving? Do images in your visual field appear mildly blurred, or do they seem to be jumping around? If you have shaky or blurred vision, you may be experiencing oscillopsia, a neurovisual condition that can impact almost every aspect of your life if left untreated.

At Neuro Visual Center of New York, we have many years of experience treating patients with oscillopsia. Using our state-of-the-art technology, we can perform a highly specialized test to determine the root cause of your oscillopsia, which will guide our treatment plan. In today’s post, we explain what oscillopsia is and how we treat it.

Understanding Oscillopsia

Oscillopsia is the sensation that the visual world around you is fundamentally unstable. If you are driving around in a car, signs on the side of the road will appear to be moving or jumping around. Even if you’re sitting still and happen to move your head a bit, the world around you will appear to shake or jolt. This condition can cause significant distress and anxiety, and can compromise your general quality of life.

There are two types of oscillopsia: permanent and paroxysmal. Permanent oscillopsia occurs due to a misalignment in your eyes, while paroxysmal oscillopsia often results from an abnormality in your vestibular system, which controls your sense of balance.

The main symptoms of oscillopsia are that objects in your visual field appear to jump, blur or shake when you move, or sometimes even when you’re standing still. Simply moving your head is enough to trigger the visual instability, but bigger movements like walking, running or driving in a car can be particularly disorienting for patients with this condition.

Oscillopsia and Vertical Heterophoria

Vertical heterophoria (VH) is a condition that results from a misalignment in your eyes, which causes you to see images unevenly—e.g., your left eye might perceive an image to be slightly higher than your right eye perceives it. Your brain rejects double images, so it forces your extraocular muscles, the tiny muscles that control the movement of your eyes, to correct the misalignment so one clear image is transmitted.

The work of constantly having to correct the misalignment in your eyes can cause your ocular muscles to become strained and fatigued, which leads to a number of symptoms including headaches and dizziness. It can also cause oscillopsia and related symptoms of blurred or shaky vision.

Our Diagnosis and Treatment Process

During a two-hour exam, we will use our state-of-the-art equipment to look for the tiny misalignments in your eyes that are indicative of VH and oscillopsia. We use special aligning prismatic lenses to treat these conditions. Unlike typical eyeglass lenses, which correct refractive errors such as nearsightedness or farsightedness, our aligning prismatic lenses correct the misalignment in your eyes that is putting the strain on your extraocular muscles. This treatment can dramatically reduce or even completely eliminate symptoms.

For more information on VH and oscillopsia, or to schedule an appointment, call the Neuro Visual Center of New York today at (516) 224-4888.

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