Scleral Lenses
What Are Scleral Lenses?
Unlike traditional contact lenses that sit directly on your cornea, scleral lenses are much larger and rest on the conjunctiva overlying the sclera, the white part of your eye. This unique design allows the lens to vault over your cornea without touching it. The extra size offers stability and creates a protective cushion of fluid between the lens and your eye.
Standard soft lenses measure about 14 millimeters across, while scleral lenses range from 14.5 to over 20 millimeters in diameter. Because they rest on less sensitive tissue, many patients find scleral lenses more comfortable than smaller options.
When we place a scleral lens on your eye, it creates a smooth optical surface that corrects vision problems caused by an uneven cornea. The lens bridges over any irregularities, scars, or distortions on your corneal surface. This design allows light to focus properly on your retina, giving you clearer, sharper vision.
The space between the back surface of the lens and your cornea is filled with preservative-free saline solution at insertion. The reservoir can change over the day through tear exchange and evaporation, and some patients may need to remove and refill their lenses midday. This liquid layer protects your cornea and helps keep it hydrated, which is especially helpful if you have dry eye disease.
The fluid reservoir is one of the most important features of scleral lens design. When you insert your lens, you fill it with sterile saline solution, creating a cushion that bathes your cornea. This reservoir provides therapeutic benefits beyond vision correction.
- Helps keep your cornea moist and more comfortable during wear
- Protects the corneal surface from friction and environmental irritants
- Supports a stable tear film for clearer vision
- High-oxygen-permeable lens materials allow oxygen to reach your cornea, though very thick lenses or reservoirs may reduce oxygen availability
- The reservoir can collect tear debris and proteins, which may cause midday fogging in some patients
Who Benefits from Scleral Lenses?
Keratoconus causes your cornea to thin and bulge into a cone shape, making standard contacts unstable and glasses less effective. Scleral lenses vault over the irregular cone and create a new front surface for your eye. They provide excellent vision and all-day stability without rubbing on the sensitive corneal tissue.
Many patients with keratoconus find that scleral lenses are an excellent option for achieving functional vision, though alternatives may exist depending on the severity of your condition. Other irregular cornea conditions, such as pellucid marginal degeneration or corneal ectasia (corneal weakening and bulging), also may respond well to this type of lens.
If you suffer from severe dry eye that does not respond to artificial tears or medications, scleral lenses may offer relief. The fluid chamber between the lens and your cornea acts as a bandage, protecting your eye from evaporation and exposure. We often recommend scleral lenses for patients with Sjogren syndrome, graft-versus-host disease, or other conditions that cause chronic dryness.
The moisture provided by the saline reservoir may reduce your symptoms, though results vary from patient to patient. Many of our dry eye patients report that scleral lenses allow them to work, read, and enjoy activities that were previously too uncomfortable. Scleral lenses complement, rather than replace, your underlying dry eye management and treatment plan.
Corneal scars from injury, infection, or previous surgery can create irregular surfaces that blur your vision. Scleral lenses mask these imperfections by vaulting over them and providing a smooth optical interface. If you have had corneal transplant surgery, radial keratotomy, or LASIK complications, scleral lenses may restore functional vision.
- Hide scars and irregularities optically
- Improve comfort on sensitive or damaged tissue
- May help delay additional surgery in some cases, depending on your individual condition
- Support healing after certain corneal procedures
- Post-transplant and post-surgical corneas require close monitoring and co-management with your corneal specialist
Patients with very high amounts of nearsightedness, farsightedness, or astigmatism sometimes find that glasses are too thick or heavy. Standard contact lenses may not provide crisp vision or may rotate out of position if you have a lot of astigmatism. Scleral lenses can correct even extreme prescriptions with excellent stability and clarity.
The large diameter and custom design of scleral lenses mean they stay centered on your eye and do not shift with blinking. This stability produces sharper vision than many other correction options.
Many additional eye conditions can benefit from scleral lens wear. We may recommend them if you have Stevens-Johnson syndrome, ocular rosacea, neurotrophic keratitis (reduced corneal sensation and healing), or exposure keratopathy (corneal damage from poor eyelid closure). Patients who have lost part of their eyelid function or have persistent corneal erosions often find relief with the protection scleral lenses provide.
Some athletes and people with high visual demands also choose scleral lenses for the superior vision quality and stability they may offer. Our eye doctor will evaluate your specific situation and discuss whether scleral lenses are right for you.
The Custom Fitting Process
Your first appointment will include a comprehensive eye exam and detailed measurements of your cornea and sclera. We will review your medical history, current symptoms, and vision goals. This information helps us determine the best lens design and parameters for your unique eye shape.
We will also discuss your lifestyle, work requirements, and any concerns you have about wearing contact lenses. The more we understand about your needs, the better we can customize your lenses for optimal comfort and vision.
Modern scleral lens fitting relies on advanced imaging technology to map the contours of your eye. We use corneal topography to measure the front surface of your cornea in precise detail. Some practices also use optical coherence tomography to assess the height and depth variations across your eye.
- Corneal topography creates a color-coded map of your corneal curvature
- Scleral mapping captures the shape of the white part of your eye
- Elevation maps show any bumps, valleys, or irregular areas
- These measurements guide the design of your custom lenses
After analyzing your eye shape, we will select trial lenses to test on your eye. You will wear each trial lens for a short time while we evaluate the fit using a specialized microscope. We check for proper vault over your cornea, alignment on your sclera, and edge clearance to ensure comfort.
We may try several different trial lenses before finding the best match. Each adjustment brings us closer to the ideal fit that balances vision, comfort, and eye health. Once we finalize the design, we order your custom lenses from the laboratory.
The complete fitting process typically requires two to four visits over several weeks. Your first visit may take one to two hours for measurements and initial trial fittings. Follow-up appointments allow us to fine-tune the fit and make any necessary adjustments.
Complex cases involving very irregular corneas or multiple eye conditions may take longer to achieve the perfect fit. We remain committed to working with you until your lenses provide excellent vision and comfort throughout the day.
Learning to Insert, Remove, and Care for Your Lenses
We will teach you how to insert your scleral lenses using a small handheld plunger or your fingertips. You will fill each lens with preservative-free sterile saline solution before placing it on your eye. Proper filling technique prevents air bubbles from forming under the lens, which could blur your vision or cause discomfort. If you notice a bubble or hazy vision immediately after insertion, remove the lens, refill it completely, and reinsert it rather than wearing it with the bubble present.
Most patients become comfortable with insertion after a few practice sessions. We provide step-by-step training and will not send you home until you can handle your lenses confidently. You may feel awkward at first, but the process becomes quick and easy with practice. Keep your plungers clean, allow them to air dry after each use, replace them periodically, and never share them with others.
Removing scleral lenses requires a gentle technique to avoid damaging your eye or the lens. Most people use a small plunger designed specifically for removal. You place the plunger on the lower edge of the lens and gently break the seal, allowing the lens to come off your eye smoothly.
- Wash and dry your hands thoroughly before removal
- Look up and pull your lower eyelid down to expose the lens edge
- Apply the plunger to the lower third of the lens
- Gently pull outward to release the suction and lift the lens away
Proper cleaning is essential to prevent eye infections and keep your lenses in good condition. Each time you remove your lenses, rinse them with sterile saline and then clean them with a recommended contact lens cleaner. Rub each surface gently with your fingertip to remove protein deposits and debris. Remember that saline solution rinses debris but does not disinfect your lenses. You must use an approved disinfection system every time you remove your lenses unless our eye doctor provides a different therapeutic protocol for your specific situation.
After cleaning, rinse your lenses again with fresh saline before placing them in a disinfecting solution overnight. Never use tap water on your lenses, as it can harbor microorganisms that cause serious eye infections. Follow the exact care routine our eye doctor prescribes for your specific lens material.
- Rub and rinse each lens with cleaner as directed
- Place lenses in fresh disinfecting solution for the full recommended time
- Rinse lenses with saline before insertion if your disinfection system requires this step
- Allow your lens case to air dry completely between uses
- Never top off old solution with new solution
We will recommend specific contact lens solutions that are safe and effective for scleral lenses. Always use preservative-free saline for filling your lenses at insertion time. For cleaning and disinfection, use hydrogen peroxide systems or multipurpose solutions approved for rigid gas permeable lenses. If you use a hydrogen peroxide system, the peroxide must be fully neutralized before the lenses touch your eyes. Never put hydrogen peroxide directly in your eye, never fill your lens with peroxide, and always follow the neutralization timing exactly as directed.
Avoid solutions containing preservatives when filling your lenses, as preservatives can become trapped against your cornea and cause irritation. Use single-use vials of preservative-free saline when possible, avoid making homemade saline, and discard opened saline vials according to package instructions. Never reuse saline or disinfecting solution, and replace your lens case regularly to prevent contamination.
Store your scleral lenses in a clean case filled with fresh disinfecting solution whenever you are not wearing them. Keep the case in a cool, dry place away from direct sunlight. Replace your lens case at least every three months, or sooner if it becomes damaged or difficult to clean.
Always mark your lens case to identify which lens goes in which eye. Mixing up your lenses can cause blurry vision and discomfort. If you will not be wearing your lenses for an extended period, consult our office about the best storage method.
What to Expect When Wearing Scleral Lenses
Most patients find scleral lenses comfortable from the first day because the lenses rest on less sensitive tissue. You may notice a slight awareness of the lens edges initially, but this sensation typically fades within a few days. Your eyes need time to adapt to the new feeling and to the presence of the fluid reservoir.
Some people experience minor redness or irritation during the first week as their eyes adjust. These symptoms usually resolve quickly. If discomfort persists beyond the initial adjustment period, contact our office so we can evaluate the fit and make any needed changes.
We generally recommend wearing scleral lenses for eight to twelve hours per day, depending on your individual needs and eye health. Many patients can comfortably wear their lenses for a full workday or school day. You should remove your lenses before sleeping unless our eye doctor specifically prescribes overnight wear for therapeutic reasons.
- Start with shorter wearing times during your first week
- Gradually increase wear time as your eyes adapt
- Listen to your body and remove lenses if you experience discomfort
- Follow the wearing schedule we establish during your fitting appointments
Many patients notice improved clarity with scleral lenses. You may see sharper details, better contrast, and reduced glare compared to glasses or other contact lenses. Some patients report that scleral lenses provide very good vision, especially if they have keratoconus or irregular corneas.
Your vision should remain relatively stable throughout the day since the fluid reservoir helps prevent your cornea from drying out. The quality of vision you achieve will depend on your individual eye condition and the fit of your lenses.
You should remove your scleral lenses right away if you experience sudden sharp pain, significant redness, or a dramatic decrease in vision. If you notice flashing lights, see new floaters, or develop light sensitivity that does not go away, take out your lenses and contact our office immediately.
Any sign of infection, such as discharge, crusting, or swelling of your eyelids, requires prompt attention. Do not try to push through discomfort or assume symptoms will resolve on their own. Early intervention prevents minor problems from becoming serious complications.
Certain symptoms indicate that your lenses need adjustment or that your eyes require evaluation. Persistent foggy vision after the first hour of wear may mean the lens vault is incorrect, air bubbles are trapped under the lens, or debris has accumulated. Rocking or movement of the lens on your eye suggests poor fit.
- Redness that does not clear after removing your lenses
- Persistent discomfort or foreign body sensation
- Hazy or fluctuating vision throughout the day
- Difficulty keeping your lenses in place
- Unusual discharge or tearing
Risks, Side Effects, and When Not to Wear Them
Most side effects of scleral lens wear are minor and temporary. You may notice some of these effects during your adjustment period or occasionally during regular wear. Report any persistent or worsening symptoms to our office so we can evaluate your lenses and eye health.
- Temporary redness or small blood vessels on the white of your eye
- Indentation rings or marks on the conjunctiva where the lens rests, usually fading after lens removal
- Mild dryness or irritation during the adaptation phase
- Transient blur or fogging after several hours of wear
- Awareness of the lens edge, especially during the first few days
Serious complications are uncommon when you follow proper lens care and wearing schedules, but they require immediate attention if they occur. Contact our office the same day if you experience moderate symptoms. Seek emergency eye care immediately for severe pain, rapid vision loss, or signs of infection.
- Severe eye pain that does not improve after removing your lenses
- Rapidly worsening redness or a bright red eye
- Marked sensitivity to light or inability to open your eye comfortably
- Thick discharge, crusting, or pus from your eye
- Sudden significant decrease in vision or a white spot on your cornea
- Eye injury or trauma while wearing lenses
- Chemical exposure to your eye
Scleral lenses are not appropriate for everyone. We will carefully evaluate your eye health and individual situation before recommending this option. Your eye doctor will discuss alternatives if scleral lenses are not suitable for you.
- Patients with very low corneal endothelial cell counts or significant Fuchs dystrophy may be at higher risk for corneal swelling
- Active eye infections or severe untreated inflammation require resolution before lens fitting
- Difficulty with hand coordination or hygiene that prevents safe lens handling and cleaning
- Inability to attend required follow-up appointments for monitoring and adjustments
- Certain eye surgeries or anatomical features may make fitting more difficult or require specialized designs
- Very advanced corneal disease may require other medical or surgical interventions first
Water exposure while wearing scleral lenses increases your risk of serious eye infections. Follow strict water avoidance guidelines to protect your eyes. If accidental exposure occurs, take appropriate steps immediately.
- Never swim, shower, or use hot tubs while wearing your scleral lenses
- Remove your lenses before any water activities
- If your lenses are accidentally exposed to water, remove them immediately, clean and disinfect them thoroughly, and do not reinsert until the full disinfection cycle is complete
- Contact our office if you develop any redness, pain, or discharge after water exposure
Follow-Up Care and Lens Replacement
After you receive your custom scleral lenses, we will schedule follow-up appointments to monitor your progress. Your first check-up may occur within one to seven days of starting full-time wear, depending on your eye condition and our eye doctor's protocol. We will examine your eyes with your lenses in place to assess fit, vault height, and corneal health. Follow the specific schedule we prescribe for your situation.
Annual eye exams are essential for all scleral lens wearers. We check for any changes in your corneal shape, update your prescription if needed, and evaluate the condition of your lenses. Regular monitoring helps us catch small issues before they affect your vision or eye health.
Scleral lenses typically last one to three years with proper care, though this varies based on lens material and your individual circumstances. We will inspect your lenses at each visit for scratches, deposits, or warping that could affect vision or comfort. Even if your lenses look fine, the material can change over time and affect oxygen transmission.
You will need replacement lenses sooner if they become damaged, if your prescription changes, or if your corneal shape shifts. Never continue wearing lenses that are cracked, chipped, or excessively coated with deposits, as they can harm your eyes.
Your vision prescription may change due to natural aging, progression of eye disease, or successful treatment of your underlying condition. We will check your prescription at each annual exam and update your lenses if necessary. Some conditions like keratoconus can stabilize over time, while others may progress and require lens modifications.
If your vision becomes blurry or you need to strain to see clearly, schedule an appointment before your regular check-up. Timely prescription updates ensure you always have the sharpest possible vision.
Most scleral lens problems have solutions that we can address together. Midday fogging is a common issue with multiple possible causes, including tear debris or inflammation, protein deposits on the lens surface, poor tear exchange at the lens edge, solution sensitivity, or air bubbles working their way under the lens. While lens vault that is too low can contribute to fogging, it is not the only explanation, and we will need to evaluate your specific situation.
Persistent fogging, redness, discomfort, or vision changes should prompt an in-office evaluation rather than self-directed adjustments. We can assess your lens fit, examine your ocular surface health, and modify your lens design or care routine as needed.
- Edge discomfort may require modifications to the lens periphery or landing zone
- Redness often improves with solution changes, wearing time adjustments, or fit modifications
- Dryness symptoms may require different filling solutions or midday lens removal and refilling
- Debris under the lens calls for better cleaning practices, environmental changes, or treatment of underlying ocular surface inflammation
Frequently Asked Questions
Scleral lenses are generally not painful and many patients find them more comfortable than standard contacts because they rest on less sensitive tissue. You may feel slight awareness of the edges during the first few days, but true pain is not normal and indicates a problem that needs our attention.
Scleral lenses rarely fall out because their large diameter and custom fit create excellent stability. They are much more secure than smaller lenses and stay in place during sports, exercise, and normal daily activities. The wide landing zone on your conjunctiva and sclera holds them firmly without the discomfort of tight-fitting smaller lenses.
Scleral lens costs vary depending on the complexity of your condition, the number of fitting visits required, and your geographic location. The investment typically includes the custom lens design, professional fitting services, training, and follow-up care. Many insurance plans cover a portion of scleral lens costs when they are medically necessary, and we can help you understand your benefits.
We do not recommend sleeping in scleral lenses unless our eye doctor prescribes overnight wear for specific therapeutic reasons. Removing your lenses each night allows your corneas to receive maximum oxygen and reduces the risk of complications. Always follow the wearing schedule we establish for your particular situation.
If your lens cracks or breaks, stop wearing it immediately to avoid eye injury. Contact our office right away so we can order a replacement lens. We recommend keeping a backup pair of lenses if possible, especially if you depend on scleral lenses for functional vision. Never try to repair a damaged lens yourself.
Scleral lenses are one of several options for vision correction, and the best choice depends on your individual eye condition, lifestyle, and goals. Alternatives may include glasses, soft toric contact lenses, smaller rigid gas permeable lenses, hybrid lenses, or in some cases surgical options such as corneal cross-linking for progressive ectasia. We will discuss all appropriate options with you and explain the advantages and limitations of each approach for your specific situation.
Getting Help for Scleral Lenses
Our eye doctor specializes in custom scleral lens fitting for patients with complex vision needs. We use advanced diagnostic equipment and work closely with you to achieve the best possible vision and comfort. If you think scleral lenses might help your eyes, schedule a comprehensive evaluation to discuss your options.