page_title: Multiple sclerosis signs and symptoms
section_title: Internuclear ophthalmoplegia
hierarchical_section_title: Multiple sclerosis signs and symptoms / Internuclear ophthalmoplegia
caption_attribution_description: English: Schematic of R INO
context_page_description: Multiple sclerosis can cause a variety of symptoms: changes in sensation, muscle weakness, abnormal muscle spasms, or difficulty moving; difficulties with coordination and balance; problems in speech or swallowing, visual problems, fatigue and acute or chronic pain syndromes, bladder and bowel difficulties, cognitive impairment, or emotional symptomatology. The main clinical measure in progression of the disability and severity of the symptoms is the Expanded Disability Status Scale or EDSS.
  The initial attacks are often transient, mild, and self-limited. They often do not prompt a health care visit and sometimes are only identified in retrospect once the diagnosis has been made after further attacks. The most common initial symptoms reported are: changes in sensation in the arms, legs or face, complete or partial vision loss, weakness, double vision, unsteadiness when walking, and balance problems; but many rare initial symptoms have been reported such as aphasia or psychosis. Fifteen percent of individuals have multiple symptoms when they first seek medical attention.
context_section_description: Internuclear ophthalmoplegia is a disorder of conjugate lateral gaze.  The affected eye shows impairment of adduction.  The partner eye diverges from the affected eye during abduction, producing diplopia; during extreme abduction, compensatory nystagmus can be seen in the partner eye. Diplopia means double vision while nystagmus is involuntary eye movement characterized by alternating smooth pursuit in one direction and a saccadic movement in the other direction.
  Internuclear ophthalmoplegia occurs when MS affects a part of the brain stem called the medial longitudinal fasciculus, which is responsible for communication between the two eyes by connecting the abducens nucleus of one side to the oculomotor nucleus of the opposite side. This results in the failure of the medial rectus muscle to contract appropriately, so that the eyes do not move equally (called disconjugate gaze).
  Different drugs as well as optic compensatory systems and prisms can be used to improve these symptoms.
  Surgery can also be used in some cases for this problem.
caption: Schematic demonstrating right internuclear ophthalmoplegia, caused by injury of the right medial longitudinal fasciculus
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