Are Scleral Lenses an Effective Option for Corneal Scarring?
Understanding Corneal Scarring
Your cornea is made up of carefully arranged layers of tissue that normally stay crystal clear. When the cornea is injured or infected, your body repairs the damage with scar tissue. This scar tissue is cloudier and less organized than healthy corneal tissue, blocking or scattering light as it enters your eye.
Scars can be thin and barely noticeable or thick and opaque, depending on how deep the original injury went. Even a small scar in the center of your cornea can cause significant vision problems because it sits directly in your line of sight.
Corneal scars interfere with vision in two main ways. First, they block light from passing through clearly, creating cloudy or hazy areas in your field of view. Second, they create bumps and valleys on the corneal surface, distorting the path of light and causing blurry or wavy vision.
- Blurred vision that glasses cannot fully correct
- Glare and halos around lights, especially at night
- Reduced contrast, making it hard to see details
- Cloudy or foggy patches in your vision
Many people first notice that their vision has become blurry or that their glasses prescription no longer works well. You might find yourself squinting more often or struggling to read street signs. Colors may seem washed out, and bright lights can feel uncomfortable or create starburst patterns.
If you also have pain, redness, or sensitivity to light, these signs suggest active inflammation or infection that needs immediate attention. Any sudden change in vision should prompt a visit to our eye doctor to determine the cause and protect your sight.
Corneal scarring develops from a variety of injuries and diseases. Infections like bacterial keratitis or herpes simplex virus can eat away at corneal tissue, leaving scars behind when they heal. Trauma from accidents, foreign objects, or chemical burns can also damage the cornea permanently.
- Eye infections, especially if not treated quickly
- Contact lens related corneal ulcers or microbial keratitis
- Injuries from scratches, cuts, or chemical exposure
- Surgical complications from previous eye procedures
- Severe dry eye with persistent epithelial defects that can lead to surface breakdown
- Keratoconus with prior corneal hydrops leading to post-hydrops scarring
- Neurotrophic keratopathy or exposure keratopathy with chronic surface problems
- Severe allergic eye disease such as vernal or atopic keratoconjunctivitis
- Autoimmune or inflammatory keratitis
- Inherited corneal diseases such as corneal dystrophies that can cause haze or opacities
Diagnosing Corneal Scarring
We begin with a careful look at the front surface of your eye using a special microscope called a slit lamp. This instrument shines a thin beam of light through your cornea, allowing us to see the exact location, size, and depth of any scars. We can spot even tiny defects that might be causing your vision problems.
We also test your vision with different lenses to see how much improvement is possible. If we can sharpen your sight significantly with trial lenses or a rigid lens over-refraction, it tells us that the scar is mainly causing irregular shape rather than blocking light completely. We may also use techniques to assess your visual potential when opacity is present.
Corneal topography creates a detailed color map of your cornea, showing us every hill and valley on its surface. This test helps us understand how the scar has distorted the normal dome shape. Optical coherence tomography, or OCT, takes cross-sectional images that reveal how deep the scar extends into the corneal layers.
- Corneal topography to map surface irregularities
- OCT imaging to measure scar depth and thickness
- Pachymetry to check corneal thickness
- Visual acuity testing with multiple lens options
The location of your scar matters more than its size when it comes to vision. A tiny scar in the very center of your cornea can blur your vision more than a larger one off to the side. We measure how much of your visual axis the scar covers and how irregular the corneal surface has become.
Deep scars that reach through multiple corneal layers tend to cause more clouding, while superficial scars mainly create surface irregularity. Central scars with significant opacity can limit your best-corrected vision even when we perfectly neutralize the surface irregularity with contact lenses. We also look for signs that the scar is stable or still changing, which affects what treatments we recommend.
We consider many factors when planning your care. Your current vision level, the scar characteristics, your daily visual needs, and your overall eye health all play a role. We also discuss your preferences, like whether you are comfortable wearing contact lenses or if you would consider surgery.
Our goal is to find the approach that gives you the clearest, most comfortable vision with the least risk and inconvenience. Sometimes we start with a simpler option and move to more advanced treatments if needed.
Treatment Options for Vision Loss from Corneal Scarring
For mild scarring that mainly affects your prescription rather than creating severe irregularity, regular glasses or soft contact lenses might provide acceptable vision. This is more likely if your scar is small, located away from the center, or very superficial. We always try the simplest solution first when it can meet your needs.
- Best for mild, peripheral scars
- Works when there is minimal surface irregularity
- Easiest to adapt to and maintain
- Usually the most affordable option
Rigid gas permeable lenses, or RGP lenses, are smaller hard lenses that rest on your cornea and create a smooth front surface. The tear layer between the lens and your irregular cornea fills in the valleys and levels off the bumps, improving vision. These work well for moderate irregularity but can be uncomfortable if your scar is raised or your cornea is very steep.
Hybrid lenses combine a rigid center with a soft outer skirt for better comfort. They can handle some irregularity while feeling more like soft lenses, making them a good middle option for certain patients.
Scleral lenses are large, rigid lenses that vault over your entire cornea and rest on the white part of your eye, called the sclera. They create a fluid-filled space over your cornea, bathing it in saline solution and creating an optical surface that bypasses corneal irregularities. Because they are designed to vault the cornea with a fluid reservoir, the goal is minimal to no corneal bearing, though the fit must be confirmed and monitored on exam.
These lenses require special fitting and training to insert and remove safely. We measure your eye carefully and often make several lens adjustments to achieve the best fit and vision.
For some types of superficial scars, laser treatment called phototherapeutic keratectomy, or PTK, can smooth the corneal surface by removing thin layers of tissue. This works best for scars that do not penetrate deeply and when enough healthy cornea remains underneath. PTK can treat superficial anterior stromal scarring and improve surface regularity in select cases, but outcomes depend on scar depth, location, and cause. The procedure carries risks including haze formation, refractive shifts, and limits based on residual corneal thickness. We use advanced imaging to plan these treatments precisely.
- PTK laser to smooth surface irregularities in superficial scars
- Anti-inflammatory medications if the underlying inflammation or infection remains active
- Treatment of underlying dry eye or infection
- Bandage contact lenses during healing
When scarring is very dense, deep, or covers a large area, corneal transplant surgery may be necessary. We remove the damaged corneal tissue and replace it with healthy donor tissue. For stromal scarring when the endothelium is healthy, we may perform deep anterior lamellar keratoplasty, or DALK, which replaces the front and middle layers. Full-thickness transplants, called penetrating keratoplasty or PKP, replace all the corneal layers and are used for full-thickness disease or when the endothelium is compromised.
Endothelial keratoplasty procedures such as DMEK or DSAEK are mainly used for endothelial failure like Fuchs dystrophy or bullous keratopathy, rather than for typical stromal scarring. Transplant surgery carries risks including rejection, infection, and irregular healing that might still require specialty contact lenses afterward. We reserve this option for cases where vision cannot be adequately restored with lenses alone or when the cornea is structurally unsound.
We match the treatment to your specific situation by weighing benefits, risks, and your goals. Younger patients with many years of vision needs ahead might benefit from different choices than older patients. Your ability to handle lens insertion, your lifestyle demands, and any other eye conditions also guide our recommendations.
Often we use a stepwise approach, starting with the least invasive option that has a good chance of success. If your vision goals are not met, we can move to the next level of treatment while learning valuable information from each step.
Scleral Lenses for Corneal Scarring: Benefits and Considerations
Scleral lenses measure 14 to 24 millimeters in diameter, much larger than standard contact lenses. You fill them with preservative-free saline before insertion, creating a liquid reservoir between the lens and your cornea. This fluid layer serves three purposes: it corrects the irregular shape, keeps your cornea moist, and protects the scarred surface.
The lens edge sits on your sclera, which has fewer nerve endings than your cornea, so many people find them more comfortable than smaller lenses even though they look bigger. The vault over your cornea is adjusted during fitting to aim for minimal to no bearing over the scar, and we monitor clearance over time as the fit may change during wear.
Scleral lenses excel at correcting vision in scarred corneas because they mask even severe irregularities. The large diameter means the optical zone is big enough to cover your entire cornea, and the rigid material creates a smooth front surface. Because they do not move much once inserted, your vision stays stable throughout the day.
- Vault over scars with minimal corneal contact when properly fitted
- Provide stable, clear vision despite severe irregularity
- Keep the cornea moist with the saline reservoir
- Often more comfortable than smaller rigid lenses
- Can correct very high prescriptions along with irregularity
We often recommend scleral lenses when you have moderate to severe corneal irregularity from scarring that cannot be corrected with glasses or soft lenses. They are particularly valuable if your scars are central, if you have tried smaller rigid lenses but found them uncomfortable, or if you also have severe dry eye. Scleral lenses work well when your scar is stable and the rest of your eye is healthy enough to wear contact lenses safely.
Patients who need excellent vision for work or daily activities and want to avoid or delay surgery often achieve their goals with scleral lenses. They are also useful after corneal transplant if the new cornea heals with some irregularity.
Scleral lenses are not always the best choice. If your scarring is very mild, simpler and less expensive options like glasses might work just as well. When a scar is so dense that almost no light passes through, even the best lens cannot improve vision much, and transplant surgery becomes necessary.
- Very mild scarring that responds to glasses
- Dense central scars blocking most light transmission
- Active eye infections or severe inflammation
- Inability to handle or care for the lenses safely
- Structural corneal problems needing surgical repair
- Severely reduced endothelial cell count or chronic corneal edema requiring careful evaluation
- Glaucoma drainage devices or filtering blebs that may interact with the lens
- Severe conjunctival scarring or cicatrizing disease
- Poor corneal sensation or neurotrophic cornea requiring closer monitoring
Like all medical devices, scleral lenses carry some risks. Most complications can be prevented or managed with proper fitting, careful hygiene, and regular follow-up care. Understanding these risks helps you recognize problems early and maintain healthy lens wear.
- Corneal swelling or hypoxia, especially if you have reduced endothelial reserve
- Redness or discomfort from landing zone compression or impingement
- Suction effects and potential epithelial disruption during removal
- Midday fogging as debris accumulates in the fluid reservoir
- Infection risk, including microbial keratitis, emphasizing the importance of strict hygiene
- Giant papillary conjunctivitis or allergic reactions to lens care solutions
- Need for refitting if your eye shape changes after surgery or from disease progression
Getting Fitted and Adjusting to Scleral Lenses
Fitting scleral lenses takes more time and expertise than fitting standard contacts. We start by taking detailed measurements and images of your cornea and sclera. Using this data, we order a trial lens and evaluate how it fits, checking the vault height, edge alignment, and movement. We also test your vision and comfort with the lens in place.
Most patients need several visits with lens modifications before we finalize the prescription. We teach you how to insert and remove the lenses using special techniques and tools. The fitting process can take weeks, but the result is a custom lens designed specifically for your eye.
Many people notice improved vision immediately, but it takes time to master insertion and removal. Your eyes may feel slightly aware of the lenses at first, though most wearers adapt within a few days to a couple of weeks. You should gradually increase your wearing time rather than trying to wear them all day right away.
Some people experience mild fogging of vision after several hours as debris collects in the fluid reservoir. Removing and refilling the lens usually solves this. We work with you to troubleshoot any issues and make adjustments until you are comfortable and seeing your best.
Caring for Scleral Lenses and Maintaining Eye Health
Inserting scleral lenses requires clean hands, a steady surface, and sometimes a small suction tool. You fill the bowl of the lens with preservative-free saline, lean over, and gently place it on your eye while looking straight ahead or down. The lens should settle onto your sclera without trapping air bubbles under the center.
- Wash your hands thoroughly before handling lenses
- Fill the lens bowl completely with sterile saline
- Use a mirror and good lighting for placement
- If you see a central air bubble or experience discomfort or blur right away, remove the lens, refill, and reinsert
- Apply a small suction cup to the lens surface for removal using the technique taught in clinic
- Do not forcibly pry the lens off the eye; use approved removal methods
Proper lens care requires distinct steps for cleaning, disinfecting, and filling. After removal, clean your lenses by rubbing them gently with a gas permeable lens cleaner approved by our eye doctor. Rinse thoroughly with sterile gas permeable rinse or approved solution, never tap water. Disinfect the lenses by storing them in a hydrogen peroxide system or gas permeable disinfecting solution as directed. Only fill the lens with sterile preservative-free saline immediately before insertion.
- Rub clean with GP approved cleaner after removal
- Rinse with sterile GP rinse or approved solution, never tap water
- Disinfect with peroxide system or GP disinfecting solution as directed
- Fill only with sterile preservative-free saline just before insertion
- Clean, rinse, and air dry your lens case daily
- Replace your lens case on a regular schedule, for example monthly or per manufacturer instructions
Always store your lenses in a clean, dry case filled with fresh solution. Keep your lenses away from water sources like sinks, showers, and swimming pools, as tap water can harbor dangerous microorganisms including those that cause serious infections. Handle your lenses over a soft towel or padded surface so they do not crack if dropped.
Mark your lens cases right and left to avoid mixing them up. Keep backup saline and solution with you in case you need to remove and reinsert your lenses during the day.
We schedule regular follow-up visits to check your lens fit, your corneal health, and your vision. At these appointments, we look for signs of complications like corneal swelling, blood vessel growth, or changes in your scar. We also evaluate the lenses themselves for scratches, deposits, or warping that could affect performance.
- Typical initial follow-ups may include visits at one day, one week, and one month, though timing varies based on individual needs
- Ongoing visits every three to six months for stable wearers
- Annual comprehensive eye exams
- Immediate appointments if problems develop
Most scleral lenses last one to three years with proper care, though this varies based on lens material, how much you wear them, and how well they are maintained. We check your lenses at each visit and let you know when they need replacement. Never wear lenses that are cracked, scratched, or no longer fit properly, as they can damage your eyes.
Your prescription may also change over time, requiring new lenses even if the old ones are still in good shape. Keep up with your scheduled visits so we can catch these changes early.
Contact us right away if you experience sudden vision loss, severe pain, or intense redness while wearing your lenses. Remove the lenses immediately if you feel sharp pain, see flashes of light, or notice discharge. Symptoms such as flashes, floaters, or a curtain-like vision loss warrant urgent evaluation even if they persist after lens removal, as these can signal serious ocular emergencies unrelated to lens wear.
- Pain that does not go away after lens removal
- Sudden blurry vision or vision loss
- Red, swollen, or extremely watery eyes
- Discharge, crusting, or sticky eyelids
- Extreme sensitivity to light
Do not resume lens wear until you have been evaluated by our eye doctor.
Frequently Asked Questions
Scleral lenses and transplant surgery serve different purposes and are not directly comparable. Lenses correct vision by masking irregularity but do not repair the damaged cornea, while surgery replaces scarred tissue with healthy donor tissue. Many patients achieve excellent vision with scleral lenses and avoid the risks of surgery, but transplant becomes necessary when scars are too dense or the cornea is structurally weak.
Medical insurance sometimes covers scleral lenses when they are deemed medically necessary to treat a diagnosed corneal condition like scarring, rather than just for vision correction. Coverage varies widely by plan, and you may need documentation from our eye doctor explaining why standard options are inadequate. Vision insurance typically does not cover specialty contact lenses, but checking with both your medical and vision plans is worthwhile.
Yes, scleral lenses are often an excellent choice for people with both corneal scarring and dry eye disease. The saline reservoir keeps your cornea moist throughout the day, providing relief from dryness while also correcting vision. Many patients with severe dry eye who could not tolerate other contact lenses find scleral lenses comfortable and helpful.
With proper care and handling, most scleral lenses remain usable for one to three years before they need replacement due to deposits, warping, or scratches. Your individual replacement schedule depends on your lens material, how many hours per day you wear them, your tear chemistry, and how carefully you maintain them. We monitor your lenses at regular visits and advise you when new ones are needed.
If scleral lenses do not provide adequate vision improvement, we investigate why. Sometimes the fit needs adjustment, or you may need a different lens design. If the scar is blocking too much light rather than just causing irregularity, lenses alone cannot restore clear sight. In those cases, we discuss other options like laser treatment to address superficial scarring and improve surface regularity in select cases, or corneal transplant surgery to replace the damaged tissue.
Getting Help for Corneal Scarring
If you have blurry vision, see halos around lights, or have been told you have corneal scarring, our eye doctor can evaluate your condition and discuss all your treatment options. We take the time to understand your vision goals and recommend the approach that offers you the best chance of clear, comfortable sight. Schedule a comprehensive eye examination to learn whether scleral lenses or another treatment is right for you.