Scleral Lenses for Dry Eye
How Scleral Lenses Work
Scleral lenses rest on the sclera, the white part of the eye, and vault over the cornea to form a protective fluid reservoir. This unique design maintains consistent hydration and shields the ocular surface from environmental irritants.
These lenses are larger than typical contacts, usually ranging from 14 to 24 millimeters in diameter, to ensure full corneal coverage and stability. The larger size provides a comfortable fit without touching the sensitive cornea, even for eyes with irregular shapes.
The space between the back of the lens and the front of the cornea is filled with a sterile saline solution. This fluid reservoir continuously bathes the cornea, keeping the eye surface moist and smoothing out irregularities for sharper vision.
Scleral lenses are made from highly breathable materials, such as fluorosilicone acrylates, that allow sufficient oxygen to reach the cornea. This is essential for maintaining long-term corneal health and reducing redness and irritation during wear.
Modern scleral lenses are designed using advanced technology like corneo-scleral topography, which maps the unique shape of your eye. This data is used to create an individualized lens profile that improves fit, optimizes comfort, and prevents issues like air bubbles.
Benefits for Dry Eye
By combining constant hydration with clear vision correction, scleral lenses can dramatically improve comfort and daily function for patients with chronic dry eye. This helps reduce reliance on artificial tears and other temporary treatments.
The fluid reservoir under the lens keeps the eye surface consistently moist, supporting epithelial healing and reducing symptoms like itching and burning. Many patients experience relief for 8 to 12 hours of comfortable daily wear.
Scleral lenses form a physical barrier against environmental irritants such as dust, wind, and allergens. This protective seal can significantly improve comfort for patients who have environmental sensitivities or allergies.
By smoothing out corneal irregularities caused by dryness or other conditions, scleral lenses provide stable and clear vision. This enhancement is especially beneficial for activities like reading, driving, and using digital screens.
The stable tear film and protective design help minimize inflammatory responses on the ocular surface. Consistent hydration supports the long-term health of the eye and can reduce the need for frequent use of anti-inflammatory medications.
Who Is a Candidate?
A thorough evaluation with an eye care provider can determine if scleral lenses are the right option for you. They are often recommended for individuals who have not found adequate relief with other treatments.
Patients with advanced dry eye disease who find minimal relief from artificial tears, gels, or ointments are often ideal candidates. Scleral lenses offer a more consistent and longer-lasting form of hydration.
Conditions such as keratoconus, corneal dystrophies, or scarring from injury or infection can create irregular surfaces and dryness. Scleral lenses vault over these irregularities, providing both vision correction and moisture.
Patients who cannot tolerate soft or traditional rigid gas-permeable lenses due to discomfort or dryness often adapt well to scleral designs. The tear-filled chamber provides a cushion that enhances comfort.
Individuals who require sharp, stable vision for their profession or hobbies may benefit from scleral lenses. The moisture and clarity support extended wear during visually demanding tasks.
Some patients develop severe dryness or surface irregularities after corneal surgery, such as a transplant or LASIK. Scleral lenses can support the healing process and enhance vision quality during recovery.
The Fitting Process
A precise and personalized fitting process is critical to ensure proper lens alignment, optimal hydration, and clear vision. This process involves several steps and is performed by a specially trained eye care provider.
Your doctor will evaluate your corneal health, measure tear production, and check for any ocular surface damage. Your eyelid structure and alignment are also assessed to confirm that scleral lenses are a suitable option.
Specialized instruments are used to capture detailed measurements of the shape of your cornea and sclera. These accurate maps are essential for designing a custom lens that achieves a proper seal and a comfortable fit.
You will try on diagnostic lenses in the office to assess the initial fit, comfort, and vision. This trial phase allows your doctor to make adjustments to the lens parameters before ordering your final, customized lenses.
After you receive your lenses, follow-up appointments are scheduled to ensure they maintain a healthy fit and optimal performance. Your doctor may make fine-tune adjustments to the lens design to address comfort or vision.
High-resolution imaging techniques, such as optical coherence tomography (OCT), may be used to get a detailed view of the lens on your eye. This technology helps the doctor assess the fluid reservoir and ensure there are no areas of excessive bearing or clearance.
Lens Care and Maintenance
Proper care and handling of your scleral lenses are essential for maintaining good eye health, ensuring comfort, and maximizing the lifespan of your lenses. Following a consistent daily routine is the key to success.
Clean your lenses after each use with a recommended cleaning solution to remove proteins and other debris. Gently rub the lens surface as instructed and then rinse it thoroughly with a sterile saline solution, avoiding tap water to reduce infection risk.
Always fill the bowl of the lens with fresh, preservative-free sterile saline before insertion. Use a small plunger or other insertion tool as demonstrated by your doctor for placement and removal. To remove the lens, gently break the seal at the edge before lifting it off the eye.
Store your lenses in a clean case filled with fresh disinfecting solution whenever they are not in use. It is important to change the solution daily, clean the case regularly, and replace the case entirely every three months to prevent bacterial contamination.
Periodic in-office cleaning and polishing by your eye care provider can help remove stubborn deposits and verify the integrity of the lens material. This professional service helps extend the lifespan of your lenses and maintains safety.
Having the right supplies on hand ensures a smooth and safe lens care routine. Your doctor will recommend specific products for your needs.
- Preservative-free sterile saline solution for filling
- A multi-purpose or hydrogen peroxide-based cleaning solution
- A clean contact lens case
- Insertion and removal tools (plungers)
Potential Risks and Comfort Tips
While most patients adapt well to scleral lenses, being aware of potential risks and comfort strategies is important for successful wear. Open communication with your eye doctor will help you navigate any challenges.
Some patients may experience mild redness, light sensitivity, or irritation during the initial adaptation period. Small air bubbles trapped under the lens can also cause temporary discomfort or blurred vision and should be addressed.
If your lenses feel tight or uncomfortable, try applying preservative-free artificial tears to your eyes before insertion to reduce friction. Your doctor will also advise you on a wear schedule, starting with a few hours and gradually increasing wear time each day.
Air bubbles under the lens can impair vision and comfort. If you notice a bubble after insertion, you should remove the lens, refill it with fresh saline, and reinsert it. Proper insertion technique helps prevent bubbles from forming.
Over time, proteins from your tears can build up on the lens surface, causing cloudy vision and irritation. Use enzymatic cleaners as recommended by your doctor to prevent these deposits and keep your lenses clear.
Contact your eye care provider immediately if you experience persistent eye pain, excessive redness, discharge from your eye, or any sudden changes in your vision. Early intervention is crucial for preventing more serious complications.
Frequently Asked Questions
Here you will find answers to some of the most common questions patients have about wearing and caring for scleral lenses. Your eye care provider can offer more personalized information.
Most patients can comfortably wear scleral lenses for 8 to 12 hours per day. Your doctor will recommend a specific maximum wear time based on your individual eye health and the oxygen performance of your lenses.
While there is a learning curve, most patients find the insertion, removal, and cleaning routine manageable with practice. Our eye care team provides thorough training and support to help you master the process.
Coverage depends on your specific insurance plan and a diagnosis of medical necessity. Many plans cover a significant portion of the cost for patients with conditions like severe dry eye, keratoconus, or post-surgical complications.
The adjustment period varies, but many patients adapt to the feeling of scleral lenses within one to two weeks. Following a gradual wear schedule as prescribed by your doctor will help improve comfort during this phase.
No, it is not recommended to expose your scleral lenses to any type of water, including tap water, pools, or showers. Water can contain microorganisms that may cause serious and vision-threatening eye infections.
Sleeping in scleral lenses is not safe and is strongly discouraged. It significantly increases the risk of serious eye infections and corneal inflammation because it deprives the cornea of oxygen overnight.
With proper care, scleral lenses are typically replaced every one to two years. Your replacement schedule will depend on the condition of your lenses and your overall eye health, as determined during your regular follow-up visits.
Yes, other treatments include punctal plugs, prescription eye drops like autologous serum tears, and therapeutic procedures like IPL therapy. Your doctor can discuss all available options and recommend the best course of action for your specific condition.
Next Steps
If chronic dry eye is affecting your quality of life, scleral lenses may offer the significant, lasting relief you need. Schedule an evaluation with our experienced eye care team to determine if these advanced lenses are right for you and to begin your journey toward healthier, more comfortable eyes.