Scleral lenses are a game-changer in managing dry eye symptoms, offering continuous hydration and protection for your ocular surface. Discover their benefits today!
Dry eye disease (DED) is a chronic, multifactorial condition characterized by inflammation and an imbalance in the natural tear film. When the tear film fails to adequately lubricate the ocular surface, patients often experience itching, burning, grittiness, and even fluctuating vision. The complex interplay between reduced tear production, rapid evaporation, and inflammation disrupts the homeostasis of tissues including the cornea, conjunctiva, eyelids, lacrimal glands, and meibomian glands.
These imbalances not only cause discomfort but can also lead to long-term damage to the ocular surface. Researchers and professional bodies such as the Tear Film and Ocular Surface Society have mapped out the varied presentations of dry eye, ranging from evaporative and aqueous-deficient types to mixed forms where both mechanisms play a role. Patients who have tried topical lubricants, in-office treatments, punctal plugs, anti-inflammatory medications, and moisture goggles without sufficient relief often find themselves exploring advanced therapeutic solutions.
Scleral lenses work on a simple yet effective scientific principle. They are large-diameter rigid gas permeable lenses designed to vault over the cornea and rest on the white part of the eye, known as the sclera. This unique design creates an intervening space between the lens and the eye’s surface that is filled with a saline solution.
This constant reservoir of fluid directly bathes the cornea, providing continuous hydration throughout the day. By doing so, scleral lenses not only correct vision in patients with irregular corneas or refractive errors but also serve as a “liquid bandage” that shields sensitive ocular tissues from external irritants and the mechanical friction of blinking.
Here’s the thing: when traditional lenses or drops fail to maintain sufficient moisture, scleral lenses help re-establish the natural balance of the ocular surface. The rigid material of these lenses also creates a mechanical barrier that minimizes further trauma to the already compromised eye, making them an excellent adjunct in managing dry eye symptoms.
One of the most significant benefits of scleral lenses is their ability to hold a reservoir of non-preserved saline solution. This fluid layer is maintained around the cornea, countering the desiccating effects of a poor or unstable tear film. As the lens vaults over the cornea, it essentially “locks in” moisture, which continuously bathes the eye throughout the day.
By effectively mimicking a natural tear film, the reservoir not only alleviates discomfort but also protects the eye from environmental factors such as wind, dust, and allergens that can further aggravate dryness.
Scleral lenses act as a protective barrier against the mechanical forces of blinking. For patients with dry eye who have delicate corneal surfaces, even the friction caused by the eyelids can be disruptive. The lens, by vaulting over the cornea, prevents direct contact and minimizes the risk of epithelial abrasion and other related complications.
This protective aspect is particularly beneficial when patients have ocular surface changes stemming from systemic conditions such as Sjögren’s syndrome or graft-versus-host disease. In these scenarios, additional protection from external trauma and the reduction of friction contribute greatly to overall patient comfort.
Beyond hydration and protection, scleral lenses in many cases dramatically improve visual quality. As dry eye disease can cause light scattering due to an irregular ocular surface, the even optical surface created by the lens helps in achieving clearer and more stable vision. This improvement in optical performance is especially valuable for patients who have not found success with softer lens modalities. Furthermore the design reduces movement, and improves peripheral vision when compared to eye glasses.
Patients who previously experienced significant fluctuations in vision can enjoy a consistently improved visual outcome, thanks to the smooth refractive surface provided by the scleral lens.
Find a top optometrist near you who can help assess if scleral lenses are the right solution for your dry eye symptoms.
Scleral lenses are most beneficial for patients with moderate to severe dry eye who have not responded well to conventional therapies.
According to clinical guidelines and management reports, scleral lenses are positioned as a step three intervention in the treatment protocol. This means that they are generally not the first choice for all dry eye patients, but rather for those whose symptoms persist despite a comprehensive regimen of dry eye treatments.
Our eye doctors carefully assess each patient’s history including prior contact lens experiences, ocular surface staining, tear break-up time, and overall ocular health. Factors such as the extent of corneal sensitivity, underlying systemic conditions like Graft Vs. Host Disease or Stevens-Johnson syndrome, and previous responses to conservative treatments all play a role in determining whether a scleral lens fit is appropriate.
Getting the Right Measurements: First, our eye doctor will take detailed measurements of your eye. They'll look at things like the size of your iris (the colored part of your eye), how wide your eyes open, and the curve of your sclera. Advanced imaging tools create a detailed map of your eye’s surface to ensure the lens fits exactly to the unique shape and contours of your eye. These measurements help pick a trial lens that has the best chance of fitting comfortably.
Trying on a Test Lens: Using those measurements, our doctor will choose a trial lens to see how it fits. The lens needs to "vault" over your cornea—imagine a bridge arching over water. At first, this vault should be pretty high (about 300 to 500 microns, which is just a fancy way of saying a very tiny gap). Over time, the lens settles into place, and the gap gets smaller, ideally ending up between 100 to 300 microns.
Why the Vault Matters: If the lens vaults too high, it might not hold enough moisture. Too low, and it could touch your cornea, which isn't comfortable. The goal is a perfect balance: enough space for a healthy fluid reservoir without pressing on the eye.
Fine-Tuning the Fit: Beyond the central fit, our doctor will check the edges of the lens. They want it to sit smoothly on the sclera without too much pressure or any sharp edges lifting up. This is where they might make tiny adjustments to ensure the lens hugs your eye just right.
Checking the Fit with advanced technology: Our eye doctor will use microscopes and imaging tools to make sure everything looks good. They’ll be checking that the lens is stable and not touching the cornea in a way that could cause discomfort.
Find a top optometrist near you who can help assess if scleral lenses are the right solution for your dry eye symptoms.
Discover how scleral lenses provide continuous hydration and ocular surface protection for effective dry eye treatment.
