An Optometrist’s Guide to Inserting and Removing Scleral Lenses
Understanding Scleral Lenses and Who Needs Them
Scleral lenses are much larger than standard soft or rigid gas permeable contact lenses. They vault over the entire cornea and rest on the white part of your eye, called the sclera.
This unique design creates a fluid-filled space between the lens and your cornea, which protects the eye surface and provides exceptional vision correction. The fluid reservoir also keeps your eyes more comfortable throughout the day.
We may recommend scleral lenses for a variety of eye conditions that make traditional contacts difficult or impossible to wear.
- Keratoconus and other forms of corneal ectasia where the cornea becomes irregularly shaped
- Severe dry eye disease that makes other lenses uncomfortable
- Corneal scars or irregularities from injury, surgery, or infection
- Extreme refractive errors that cannot be fully corrected with glasses
- Eyes with very high astigmatism that require stable lens positioning
Scleral lenses are rarely prescribed solely for high refractive error without corneal irregularity or ocular surface disease.
Good candidates for scleral lenses typically have conditions that make standard contact lenses unsuitable. You may benefit from these lenses if you have an irregular cornea, chronic eye discomfort, or vision that cannot be corrected with other methods.
We also consider your ability to handle and care for the lenses, as they require more meticulous insertion and cleaning than soft contacts. Most motivated patients can learn the necessary skills with our support and training.
During your first fitting appointment, our eye doctor will take detailed measurements of your eye shape and size. We use specialized imaging equipment to map the contours of your cornea and sclera, ensuring the lens design matches your unique anatomy.
You will try diagnostic lenses in our office so we can assess the fit and make any needed adjustments. We will teach you the basics of insertion and removal at your dispensing visit when your custom lenses arrive, and we schedule follow-up visits to monitor your progress.
Preparing to Insert Your Scleral Lenses
Before you begin, gather all the items you will need for safe and successful lens insertion.
- Your scleral lenses in their storage case
- Preservative-free saline solution in single-use vials
- A clean, well-lit mirror positioned at a comfortable height
- An insertion plunger or DMV ring if recommended by our office
- Clean towels or lint-free tissues
You will also need these important supplies for proper lens care and safety.
- Separate, clearly labeled Left and Right lens cases or markers, as lenses are not interchangeable
- Your daily disinfecting system: a GP disinfecting solution or a hydrogen peroxide system as directed by our office
- A backup removal plunger and a small travel kit with single-use saline vials
- A nail trimmer or emery board to keep fingernails short and smooth
Always wash your hands thoroughly with soap and water before touching your lenses. Dry your hands with a clean, lint-free towel to avoid transferring fibers or debris to your lenses.
Set up your workspace on a clean, flat surface near a mirror with good lighting. We recommend placing a towel on the counter to cushion the lens in case you drop it during handling. Use a non-lotion, fragrance-free soap. Avoid lotions or creams before handling lenses to prevent residue.
Remove your lens from its storage case and rinse it with fresh preservative-free saline. Place the lens bowl-side up on your insertion tool or fingertip, making sure the edges form a smooth cup shape.
Fill the lens bowl completely to the brim with preservative-free saline from a single-use vial. The fluid should dome slightly above the rim without spilling over the edges.
- Inspect the lens before every insertion for chips, cracks, or debris
- Use only sterile preservative-free saline from a single-use vial. Discard the vial immediately after use
Water exposure is a major risk for serious eye infections when wearing or handling contact lenses. Always follow these strict water-safety rules.
- Never expose lenses, plungers, or cases to tap water. Do not swim, shower, or use hot tubs while wearing lenses
- Do not rinse the case or plungers with water. Use approved solution and let them air dry
- If a lens contacts water, remove, clean, disinfect, and refill with sterile saline before reinsertion
Most patients find insertion easiest when leaning forward over a flat surface, looking straight down into a mirror. This position uses gravity to help keep the saline in the lens bowl as you bring it to your eye.
Some people prefer sitting at a table with the mirror propped at an angle, while others stand at a bathroom counter. Experiment with different positions during your training to find what feels most stable and comfortable for you.
How to Insert Your Scleral Lenses
If you are using your finger for insertion, balance the saline-filled lens on the tip of your index or middle finger. Keep your hand steady and your finger level to prevent the saline from spilling.
Use your other hand to hold your upper and lower eyelids wide open, exposing enough of your eye surface for the lens to land properly. Take a slow, steady breath to help keep your hands from shaking.
We may recommend an insertion plunger or DMV ring to make handling easier, especially when you are first learning. These tools give you better control and help you keep the lens level as you approach your eye.
Attach the saline-filled lens gently to the tip of the plunger by pressing lightly on the back surface. Hold your eyelids open with your free hand and bring the lens straight toward your eye in one smooth motion. Do not press the plunger onto your eye. Attach it only to the lens.
Look straight ahead or slightly downward as you bring the lens toward your eye. Aim for the center of your eye and keep the lens as level as possible to avoid spilling saline.
Once the lens touches your eye, keep looking straight and gently release your grip on your eyelids. The lens should settle onto your eye surface in one motion, with the saline creating a cushion beneath it.
- Tuck your chin and look slightly down to help keep the fluid from spilling and to minimize bubbles
- If saline spills before the lens lands, stop and refill the bowl. Do not try to top off fluid on the eye
After insertion, look in different directions to check for air bubbles trapped under the lens. Small bubbles at the edge are usually harmless, but large central bubbles can blur your vision or cause discomfort.
If you notice a large bubble, you will need to remove the lens, refill it with saline, and reinsert it. With practice, you will learn to minimize bubbles by keeping the lens level and your eye open during insertion. If you see a central bubble, remove, refill, and reinsert. Do not attempt to push fluid under the lens.
A properly seated scleral lens should feel comfortable within a few moments of insertion. You may notice an initial awareness of the lens, but sharp pain or pressure means the lens is not positioned correctly.
Your vision should be clear and stable once the lens settles. If your vision remains blurry or you feel the lens shifting around, contact our office for guidance on adjusting your technique.
- A faint impression ring after removal is common but should fade within 30 to 60 minutes
- Sectoral blanching, persistent redness, or a deep indentation ring suggests a tight fit. Contact our office
How to Remove Your Scleral Lenses
Most patients can wear scleral lenses safely for 12 to 16 hours per day, as directed by our eye doctor and depending on your ocular health and lens design. Remove your lenses before bed each night unless our eye doctor has given you specific instructions for extended wear.
You should also remove your lenses immediately if you experience significant pain, vision changes, or increasing redness. Never wear your lenses longer than recommended, as overwear can reduce oxygen to your eyes.
We recommend using a small removal plunger designed for scleral lenses, as it makes the process safer and easier. Wash your hands thoroughly and moisten the plunger tip with a drop of preservative-free saline.
- Look straight ahead and hold your eyelids open wide
- Place the plunger slightly below center on the lens, then gently tilt or slide to break the seal
- Once the seal is broken, lift the lens away in one smooth motion
- Never pull straight out against resistance. Always break the seal first
With clean, dry hands and trimmed nails, look up. Place the finger pads of your thumb and index finger at the lower edges of the lens at about 5 and 7 o'clock, keeping nails away from the eye. Gently pinch the lens edges together while lifting slightly to break the seal and let the lens pop forward into your palm.
Alternatively, use the lower lid margin to nudge under the lens edge to release the seal. If this is difficult, use your plunger instead.
If your lens feels stuck, do not pull or tug forcefully on your eye. Instead, add a few drops of preservative-free saline to your eye to help lubricate the space under the lens.
Blink several times and gently massage your closed eyelid to encourage the lens to move. If the lens still will not budge after a few minutes, call our office for assistance rather than risking injury.
- Add several drops of preservative-free saline or approved lubricating drops and wait 1 to 2 minutes
- Use the plunger off-center and tilt or slide to break the seal before lifting
- If unsuccessful after 10 to 15 minutes, stop and call our office for urgent guidance. Do not sleep with the lens in
Cleaning, Storing, and Maintaining Your Lenses
Clean your lenses immediately after removing them each day to prevent protein and debris buildup. Place the lens in the palm of your hand and apply a few drops of the cleaning solution we recommended.
Rub the lens gently with your fingertip for about 20 seconds on each side, then rinse thoroughly with preservative-free saline. This daily cleaning helps maintain clear vision and extends the life of your lenses.
- Do not use tap water or saliva at any step
- Consider a weekly protein or enzymatic cleaner if we recommend it
Always use products specifically approved for rigid gas permeable or scleral contact lenses. We will recommend specific brands that are safe and effective for your lens material.
- Disinfect every day with either a hydrogen peroxide system or a GP disinfecting solution as directed by our office
- Use only preservative-free saline in single-use vials for filling and final rinsing. Discard vials immediately after opening
- Never store lenses in saline. Saline is not a disinfectant
- Never top off case solution. Always discard and replace with fresh disinfecting solution
- Avoid tap water, saliva, or any homemade saline solutions
Disinfect lenses every day using the system we recommended. If you use a peroxide system, complete the full neutralization time before insertion. If you use a GP disinfecting solution, follow the labeled disinfection time. Never store in saline. Do not top off solution.
Each morning, discard used solution, rinse the case with fresh disinfecting solution, and air dry face down. Replace the case at least every 3 months.
Replace your lens storage case at least every three months to reduce the risk of contamination. We may provide new cases at your regular checkup appointments, or you can purchase them as needed.
Insertion and removal plungers should be cleaned after each use and replaced every three to six months. Discard plungers sooner if you notice cracks, cloudiness, or any damage to the tips.
- Clean plungers with mild soap, rinse with sterile saline or approved solution, and air dry. Store dry
- Do not share plungers or cases
- Replace plungers every 3 to 6 months or sooner if damaged or cloudy
With proper care and handling, most scleral lenses last 1 to 2 years, and occasionally up to 3 years. The actual lifespan depends on how well you clean and store your lenses and how much protein buildup occurs on the surface. Replace sooner if you notice persistent deposits, scratches, or reduced vision.
We will examine your lenses at each follow-up visit to check for scratches, deposits, or warping. You will need a new fitting if your prescription changes significantly or if your eye shape changes over time.
Recognizing Problems and When to Contact Our Office
During the first few weeks of wear, you may notice mild awareness of the lens, slight redness after removal, or occasional blurred vision as your eyes adjust. These symptoms typically improve as you become more skilled at insertion and your eyes adapt to the lenses. Increase wear time gradually during the first week as directed, for example starting at 3 to 4 hours and adding 1 to 2 hours per day if comfortable.
Some patients also experience increased tearing or mild light sensitivity at first. If these symptoms persist beyond a month or worsen over time, schedule a follow-up visit so we can check your lens fit.
Cloudy vision after several hours of wear often means debris or protein has accumulated in the fluid reservoir under the lens. Removing the lens, cleaning it thoroughly, and reinserting it with fresh saline usually solves this problem.
If fogging happens repeatedly or starts soon after insertion, the issue may be related to your saline solution or the lens surface condition. We can help you identify the cause and adjust your care routine accordingly.
- Midday fogging often requires removing the lens, cleaning, rinsing, and refilling the bowl with fresh preservative-free saline
- Surface lubricating drops may improve comfort but typically do not clear debris trapped under the lens
- We may adjust your care products, saline type, or address eyelid oil gland health if fogging persists
Scleral lenses should never cause sharp pain or significant discomfort during normal wear. If you experience pain that does not resolve within a few minutes, remove your lenses immediately.
- Redness that worsens throughout the day or does not fade after lens removal
- Sensitivity to light accompanied by tearing or discharge
- A feeling that something is scratching your eye
- Vision loss or distortion that does not clear with blinking
- A deep, long-lasting impression ring or sectoral redness at the lens edge
- Painful tightness or pressure that worsens during the day
Take your lenses out right away if you experience sudden severe pain, a foreign body sensation that does not resolve, or a rapid decrease in vision. These symptoms may indicate a scratch on your cornea, a particle trapped under the lens, or an infection.
Also remove your lenses immediately if you notice discharge, unusual redness, or if your eye feels hot or swollen. Contact our office the same day to describe your symptoms and determine whether you need an urgent appointment. If you suspect the lens is contaminated by water or chemicals, remove, clean, and disinfect before reinsertion.
We will schedule your first follow-up visit within one to two weeks after you receive your lenses. This appointment allows us to check the lens fit, assess your eye health, and answer any questions about your care routine.
After the initial adjustment period, most patients need checkups every six to twelve months. Regular visits help us catch potential problems early and ensure your lenses continue to provide optimal vision and comfort.
Frequently Asked Questions
Most people become comfortable with insertion and removal within two to four weeks of daily practice. The first few attempts may take 15 to 20 minutes, but with experience, the entire process usually takes only a few minutes each morning and evening.
We do not recommend sleeping in scleral lenses unless our eye doctor has specifically prescribed them for overnight wear in certain medical situations. Your eyes need time without lenses each day to receive oxygen directly from the air and to recover from lens wear.
Avoid all water exposure while wearing lenses. If swimming is unavoidable, use airtight goggles and discuss risks with our office.
Use only preservative-free drops labeled for use with contact lenses on top of the lens. Remove the lens for medicated drops unless we advise otherwise.
Yes. Scleral lenses are custom and not interchangeable. Always store and insert the correct lens for each eye.
Follow our schedule. A common plan is 3 to 4 hours on day 1, adding 1 to 2 hours per day as comfort allows, up to your prescribed daily maximum.
Getting Help for Scleral Lenses
Learning to insert, remove, and care for scleral lenses is a skill that improves with practice and patience. Our eye doctor and staff are here to support you every step of the way, from your initial fitting through years of successful wear. If you have any questions or concerns at any time, do not hesitate to reach out to our office for guidance. For urgent issues outside office hours, follow our emergency contact instructions.