Bilateral “opalescent” nuclear sclerotic cataract. A 38-year-old woman with a long history of multiple sclerosis complained of a gradual decline in the vision of both eyes. This complaint prompted an admission to the hospital and an extensive evaluation including a computed tomography (CT) scan of the head, magnetic resonance imaging (MRI) of brain and orbits, a lumbar puncture, and numerous laboratory studies for presumed optic neuritis. After high-dose intravenous steroids did not help, the patient was referred for neuro-ophthalmic consultation. Not all patients with multiple sclerosis and visual loss have optic neuritis.  The basic, routine examination revealed the culprit: bilateral “opalescent” nuclear sclerotic cataract, pictured in this slitlamp photograph. The history and other examination findings supported this diagnosis (myopic shift on refraction, mild diffuse visual field loss). Cataract surgery resulted in 20/20 visual acuity and normalization of a diffusely depressed visual field. 

Source: Martin TJ, Corbett JJ. Practical Neuroophthalmology; 2013.