After reviewing the Manga, it looks like you lose a little bit of eyesight everytime you use it in MS mode. As stated above, the more it is used, the more eyesight is lost. Sasuke is the perfect example. As he used his MS, his eyesight started to become blurry. He used it quite a bit fighting Danzo and it was pretty much gone by the time Naruto and Kakashi showed up. Also, when it is not activated, no light is lost. Itachi went years without losing his eyesight. He probably used it sparingly and it last him until his death.