Scleral Lenses
What Are Scleral Lenses?
Standard contact lenses are small and rest directly on the surface of your cornea, moving slightly with each blink. Scleral lenses are much larger, ranging from 14 to 24 millimeters in diameter, and they rest on the sclera rather than the delicate cornea. This design keeps the lens stable and creates a protective reservoir of sterile saline solution between the lens and your eye.
The larger size means scleral lenses often do not fall out or move around during daily activities. Because they do not touch your cornea, many patients find them more comfortable than traditional contacts, especially if you have an irregular or sensitive corneal surface.
When we insert a scleral lens, we first fill it with a preservative-free saline solution. This liquid cushion sits between the back surface of the lens and your cornea, providing constant moisture and a smooth optical surface.
The lens vaults over any irregularities on your cornea, allowing light to focus properly on your retina for clearer vision. The gap or space between the lens and your cornea is called the clearance.
- The fluid reservoir helps keep your cornea hydrated throughout the day
- The vault design can protect damaged or irregular corneal tissue from friction
- The smooth outer surface of the lens corrects vision more consistently
- The lens may resist drying out because the front surface maintains its own tear layer
Scleral lenses come in different sizes based on their diameter and the portion of the eye they cover. Mini-scleral lenses measure 15 to 18 millimeters and are the most commonly fitted. Semi-scleral and full-scleral lenses are larger and may be used for more complex conditions or specific anatomical needs.
Each lens is custom-designed for your unique eye shape using advanced measurements and imaging. We select the type and design that best matches your condition, comfort needs, and vision goals.
Eye Conditions That Benefit from Scleral Lenses
Keratoconus is a progressive condition where the cornea becomes thin and bulges outward into a cone shape, causing distorted and blurry vision. Standard contact lenses and glasses often cannot correct the irregular astigmatism that results. Scleral lenses vault over the cone, masking the irregularity with the smooth front surface of the lens and the fluid reservoir underneath.
Other causes of irregular corneas, such as pellucid marginal degeneration or corneal ectasia, also may respond well to scleral lens correction. The lenses can restore clearer, more stable vision that may not be achievable with other methods.
Chronic dry eye can make wearing traditional contact lenses uncomfortable or impossible. Scleral lenses trap a layer of saline against your cornea, bathing it in moisture for extended periods. This reservoir can protect the ocular surface from exposure to air and may reduce symptoms such as burning, grittiness, and light sensitivity.
- The continuous hydration may support healing of the corneal surface in some patients
- The barrier effect can shield your eye from wind, dust, and low-humidity environments
- Only if specifically prescribed by our eye doctor, and only with preservative-free, lens-compatible medications under close supervision, the lenses can be filled with medicated solutions for added therapeutic benefit
- Some patients experience fogging or debris buildup during the day and may need to remove, clean, and refill the lenses midday for best comfort and vision
After surgeries such as corneal transplants, LASIK, PRK, or radial keratotomy, some patients develop irregular astigmatism or surface scarring that makes vision correction difficult. Scleral lenses can provide very good visual outcomes by compensating for these irregularities.
Many scleral lens fittings take place after the eye has healed and stabilized. When used earlier for therapeutic purposes, closer follow-up and specific indications are required. The fluid layer may also help reduce mechanical irritation on compromised tissue.
We often recommend scleral lenses for patients who have not achieved their desired vision after refractive surgery or who experience persistent discomfort. The custom fit and optical design can address residual refractive errors and surface distortions.
Giant papillary conjunctivitis, or GPC, is an inflammatory reaction on the inner eyelid, often triggered by contact lens wear. Traditional lenses that move and rub against the eyelid can worsen this condition. Because scleral lenses are larger and more stable, they may minimize friction and reduce the mechanical irritation that drives inflammation.
If you have tried multiple types of soft or rigid gas permeable lenses without success, scleral lenses offer an alternative. Managing GPC also requires attention to lens deposits, your cleaning system, replacement schedule, and sometimes a temporary break from lens wear to allow the eyelid to heal.
Patients with very high degrees of nearsightedness, farsightedness, or astigmatism sometimes struggle with glasses that are thick, heavy, or optically limiting. Scleral lenses can correct extreme refractive errors with a thinner, lighter optical system than spectacles. The large diameter also may provide a wider field of clear vision compared to smaller contact lenses.
- The custom optics can incorporate complex prescriptions, including high cylinder and sphere powers
- Multifocal or toric scleral designs can address presbyopia and astigmatism simultaneously
- The stable position on the eye helps maintain consistent optical performance throughout the day
The Scleral Lens Fitting Process
During your initial visit, we review your medical history, current symptoms, and vision goals. We perform a comprehensive eye exam to assess the health of your cornea, conjunctiva, and tear film. This appointment helps us determine whether scleral lenses are appropriate for your condition and which type of lens design will work best.
We also discuss your daily routine, occupation, and hobbies to ensure the lenses fit your lifestyle. Understanding your expectations allows us to tailor the fitting process and set realistic goals for comfort and vision improvement.
Advanced technology is essential for designing a scleral lens that fits your eye precisely. We use corneal topography to map the shape and curvature of your cornea in fine detail. Optical coherence tomography may also be used to measure the space between the lens and your eye, ensuring the proper vault height.
- Topography captures thousands of data points across the corneal surface
- Scleral mapping measures the curvature and contour of the white part of your eye
- High-resolution imaging identifies any irregularities or scarring
- These measurements guide the custom fabrication of your lenses
We start the fitting process with diagnostic trial lenses from our office inventory. You wear a trial lens while we evaluate how it sits on your eye, the clearance over your cornea and around the limbal area, and the alignment with your sclera. The limbal area is the border zone where your cornea meets the white of your eye. Using specialized instruments and dye, we check for proper edge lift, scleral landing zone alignment, and any signs of compression or blanching.
Based on what we observe, we may try several different trial lenses during the same visit. Once we identify the best base design, we order a custom lens manufactured specifically for your eye shape and prescription.
After you receive your custom scleral lenses, we schedule a follow-up appointment to assess comfort, vision quality, and lens performance. We check how the lenses settle on your eyes after several hours of wear and confirm that the vault and edge alignment remain optimal. If needed, we make adjustments to the design or order a modified lens.
Additional visits may be necessary to perfect the fit and address any issues that arise as you adapt to wearing the lenses. We monitor the health of your ocular surface at every visit to ensure the lenses are supporting, not harming, your eyes.
Most patients complete the scleral lens fitting process in four to eight weeks, though complex cases may take longer. The timeline depends on the severity of your condition, how quickly the custom lenses are manufactured, and how many adjustments are needed. We work efficiently while ensuring every detail is correct for your long-term success.
- Initial diagnostic visits typically occur one to two weeks apart
- Custom lens fabrication usually takes one to three weeks
- Fine-tuning appointments are scheduled based on your adaptation and comfort
Inserting, Removing, and Caring for Scleral Lenses
Inserting scleral lenses requires a different technique than traditional contacts because of their size. We teach you to use a small plunger or your fingertips to hold the lens like a bowl. You fill the lens completely with preservative-free saline, bend over a mirror or flat surface, and gently place the lens onto your eye while looking straight ahead. Once the lens is in place, you release it and blink to settle it.
Proper hand washing before handling your lenses is essential to prevent contamination. We demonstrate the insertion process during your fitting appointments and provide practice time until you feel confident.
The preservative-free saline you use to fill your scleral lenses serves as the therapeutic reservoir against your cornea. Using the correct solution is critical for both comfort and eye health. Only use products we recommend. Do not use any water, including tap water or distilled water, to fill or rinse your lenses. Tap water, multipurpose contact lens solutions, and solutions with preservatives can damage your cornea or the lens material.
- Fill the lens completely to the brim to avoid trapping air bubbles
- Check that the saline is sterile and has not expired
- Discard any remaining solution from single-use vials after filling your lenses
- Never reuse filling solution or top off a partially used container
- You may add preservative-free lubricating drops to the filling solution only if we specifically instruct you to do so
Removing scleral lenses is straightforward once you learn the technique. Most patients use a small removal plunger designed specifically for scleral lenses. To reduce suction and minimize risk, place the plunger slightly off-center on the lens or look away while gently breaking the seal at the edge first, then tilt the lens away from your eye. Do not pull straight out with strong suction. Alternatively, you can use your fingers to break the seal at the edge of the lens and lift it off.
Always remove your lenses over a clean, soft surface such as a towel in case you drop them. We show you both methods and help you choose the one that works best for your dexterity and comfort.
- If a lens feels stuck, instill preservative-free lubricating drops around the edge, wait a moment, and gently break the seal at the edge before attempting removal
- Never force or pull hard on a lens that will not release
- Call our office if you are unable to remove a lens safely
After removing your scleral lenses each day, follow this stepwise routine to keep them clean and safe:
- Rub-clean each lens with an approved rigid gas permeable surfactant cleaner to remove deposits and debris
- Rinse thoroughly with sterile preservative-free saline or the approved rinse solution we recommend
- Place the lenses in a clean lens case filled with fresh disinfecting solution approved for rigid gas permeable lenses, or use a hydrogen peroxide disinfection system as directed
- Allow the lenses to soak for at least four hours or overnight to ensure proper disinfection
- If using a peroxide system, ensure the solution is fully neutralized before inserting the lenses
In the morning, rinse the lenses again with preservative-free saline before filling and inserting them. Never fill the lens with disinfecting solution or peroxide, as these can seriously harm your eye. Never use saliva or tap water on your lenses. Replace your lens case every one to three months to reduce the risk of contamination.
When you are not wearing your scleral lenses, store them in fresh approved rigid gas permeable disinfecting solution or in a hydrogen peroxide disinfection system as directed by our office. This wet storage method keeps the lenses disinfected and conditioned for your next wear. Dry storage should only be done if we specifically instruct you to do so and only after proper cleaning; lenses stored dry must be fully disinfected before re-wearing.
Scleral lenses are durable and can last one to three years with proper care, though individual replacement schedules vary based on lens condition and your eye health. We inspect your lenses at every follow-up visit for scratches, deposits, or warping that might compromise vision or comfort. If damage occurs, we order replacement lenses promptly.
- Never store your lenses in water of any kind; use fresh disinfecting solution each time and do not top off old solution
- Keep solution bottle caps tightly closed to prevent contamination
- Allow your lens case to air-dry completely between uses if you use a standard two-well case
- Bring your lenses to every appointment so we can evaluate their condition
- Follow the replacement timeline we provide based on your specific lens material and wear pattern
When traveling, pack your scleral lenses in your carry-on bag to avoid loss or damage. Bring enough preservative-free saline, disinfecting solution, and lens care supplies for your entire trip, plus extra in case of delays. If you fly, the change in cabin pressure does not typically affect the lenses, but dry cabin air and prolonged wear may make your eyes feel less comfortable. Stay well hydrated and consider using preservative-free lubricating drops as needed.
Keep your lens case clean and replace it if it becomes contaminated during travel. If you lose or damage a lens while away from home, contact our office so we can help you locate a provider or arrange for a replacement to be shipped.
Common Problems and When to Call Our Office
Small air bubbles trapped under your scleral lens can occur if the lens is not filled completely before insertion or if you blink during application. Tiny bubbles usually do not affect vision or comfort, but larger bubbles can cause blurry areas or discomfort. If a bubble is bothersome, remove the lens, refill it carefully, and reinsert it.
Persistent bubbles that form after insertion may indicate an improper fit or technique issue. Contact our office if you consistently see bubbles despite using correct insertion methods, as we may need to adjust your lens design.
Cloudy vision while wearing scleral lenses can result from debris in the filling solution, deposits on the lens surface, or buildup in the fluid reservoir beneath the lens. If your vision becomes foggy after several hours of wear, remove the lens, clean it thoroughly, and reinsert it with fresh saline.
Rinsing your eye with preservative-free saline before reinsertion can also help. If cloudiness happens frequently or does not clear with cleaning, we need to evaluate your lenses and eye health. The issue may stem from solution buildup, lens material degradation, or changes in your tear chemistry.
Mild redness when you first remove your scleral lenses is normal and typically fades within 30 minutes. Redness that persists for hours or worsens over time may signal an overly tight lens, an allergic reaction, or an infection. Remove your lenses immediately and give your eyes a rest.
- Avoid reinserting the lenses until the redness resolves completely
- Use preservative-free artificial tears to soothe your eyes if we have recommended them
- Call our office if redness lasts more than a few hours or is accompanied by pain, discharge, or light sensitivity
Scleral lenses should feel comfortable throughout the day. Sharp pain, burning, or a feeling that something is scratching your eye is not normal and requires immediate attention. Pain can indicate a damaged lens, a foreign particle trapped under the lens, or an issue with your ocular surface.
Remove the lens right away and inspect it for cracks, chips, or debris. Rinse your eye with preservative-free saline. If discomfort continues after lens removal or if you notice any vision changes, contact our office the same day.
Infection is rare but serious. Warning signs include severe redness, thick discharge, intense pain, sudden vision loss, or extreme sensitivity to light. Seek same-day care if you have eye pain combined with light sensitivity and reduced vision, even without discharge. Stop wearing your lenses and contact our office immediately or seek emergency eye care if we are unavailable.
Bring your lenses, lens case, and all solutions to any urgent visit so we can evaluate them for contamination or fit issues. Other serious complications, such as corneal abrasions or inflammation, can develop if lenses are worn when your eyes are not healthy or if hygiene practices are inadequate. Always follow our care instructions and attend all scheduled follow-up appointments to catch potential problems early.
Risks, Limitations, and Who Is Not a Good Candidate
Like all contact lenses, scleral lenses carry a small risk of serious eye infection if not handled and cleaned properly. Never expose your lenses to any water, including tap water, well water, swimming pools, hot tubs, lakes, or showers, as water can introduce harmful microorganisms. Always use sterile, preservative-free saline and approved disinfection systems.
Proper hand hygiene, daily cleaning, regular case replacement, and adherence to the wear schedule we prescribe are essential to minimize infection risk. If you develop symptoms of infection, stop wearing your lenses and contact our office immediately.
Although modern scleral lenses are made from highly oxygen-permeable materials, extended wear can still limit the amount of oxygen reaching your cornea, a condition known as hypoxia. This may lead to corneal swelling, or edema, especially if lenses are worn longer than recommended. We will prescribe a maximum daily wear time based on your individual eye health and lens design.
Signs of hypoxia include blurred vision, halos around lights, and discomfort. If you experience these symptoms, remove your lenses and contact our office. Never exceed the wear time we recommend.
If a scleral lens fits too tightly, it can create excessive suction, compress blood vessels on the white of your eye, or cause blanching and redness. In some cases, tissue from the conjunctiva can be pulled or prolapsed at the lens edge during removal. These issues require a lens redesign or adjustment.
We monitor your lens fit closely at every follow-up visit. Let us know right away if you notice increasing redness, difficulty removing lenses, or discomfort that worsens throughout the day. Proper fit is essential for both comfort and long-term eye health.
Scleral lenses are not right for everyone. You may not be a good candidate if you have very low corneal endothelial cell counts, uncontrolled eyelid infections such as severe blepharitis, or conditions that prevent proper eyelid closure and expose the eye to drying. Patients who are unable to perform the cleaning and handling steps, who have limited hand dexterity, or who cannot attend regular follow-up appointments may also face challenges with scleral lens wear.
We evaluate your overall eye health, ability to care for the lenses, and commitment to the fitting process before proceeding. In some cases, other treatments or lens options may be safer or more practical for your situation.
Alternatives to Scleral Lenses
Scleral lenses are one of several specialty contact lens options available for complex vision needs. Depending on your condition, we may also consider soft toric lenses for moderate astigmatism, corneal rigid gas permeable lenses for certain irregular corneas, hybrid lenses that combine a rigid center with a soft skirt, or piggyback systems where a soft lens is worn under a rigid lens. Each option has unique benefits and limitations.
We evaluate which type of lens is most likely to meet your vision and comfort goals based on your eye anatomy, prescription, lifestyle, and medical history. Scleral lenses are part of a broader toolbox, not the only solution.
For some conditions, treatments other than contact lenses may be appropriate. For example, corneal collagen cross-linking can help slow or stop the progression of keratoconus, reducing the need for more aggressive intervention. Topography-guided laser treatments, corneal inlays, or implantable lenses may be options for certain refractive errors or irregular astigmatism. In advanced cases, corneal transplant surgery may be necessary to restore vision.
For severe dry eye, treatments such as prescription medications, punctal plugs, intense pulsed light therapy, or gland expression procedures can improve the ocular surface and reduce symptoms. Glasses remain a simple, safe option for many patients, especially when vision correction needs are straightforward. We will discuss all appropriate alternatives with you and develop a care plan tailored to your individual needs.
Frequently Asked Questions
We do not recommend sleeping in scleral lenses unless specifically prescribed for a unique medical reason. Your cornea needs oxygen, and even though scleral lenses are made of highly breathable materials, overnight wear can increase the risk of complications such as corneal swelling and infection. Always remove your lenses before sleeping to keep your eyes healthy.
With proper care and handling, scleral lenses typically last one to three years. The actual lifespan depends on the lens material, how often you wear them, and how well you maintain them. We check your lenses at regular intervals and let you know when replacement is needed to ensure optimal vision and comfort.
Insurance coverage for scleral lenses varies widely depending on your plan and the medical necessity of the lenses. Many medical insurance plans cover part or all of the cost when scleral lenses are deemed medically necessary for conditions like keratoconus or severe dry eye. We can help you understand your benefits and provide documentation to support your claim.
Yes, you can wear makeup while using scleral lenses, but we recommend inserting your lenses before applying makeup and removing them before washing your face. Choose oil-free, hypoallergenic cosmetics and avoid applying eyeliner or mascara to the inner rim of your eyelids. This approach reduces the risk of particles getting under the lens or contaminating your eyes.
Most patients find scleral lenses more comfortable than traditional contacts, especially if they have dry eyes or irregular corneas. The lenses do not touch the sensitive cornea, and the fluid reservoir provides cushioning and hydration. While there is an initial adaptation period as you get used to the larger size, the majority of wearers report very good long-term comfort.
Getting Help for Scleral Lenses
If you are experiencing vision problems, eye discomfort, or a condition that has not responded to standard treatments, scleral lenses may offer a solution. Our eye doctor will evaluate your individual needs and determine whether this specialized form of vision correction is right for you. Reach out to schedule a comprehensive evaluation and take the first step toward clearer, more comfortable vision.