Scleral Lenses for Severe Dry Eye
How Scleral Lenses Work to Relieve Severe Dry Eye
Scleral lenses are much larger than traditional soft or rigid gas permeable contact lenses. They measure between 14 and 24 millimeters in diameter, which allows them to rest on the white part of your eye called the sclera. These lenses are designed to vault over your cornea, creating a space that keeps the lens from resting on the most sensitive part of your eye. While the goal is to maintain clearance throughout wear, minimal settling or temporary contact can occur, which we monitor at your follow-up visits.
Regular contact lenses sit directly on the cornea and can worsen dryness by disrupting your tear film, increasing evaporation, and in the case of soft lenses, dehydrating on the eye. Scleral lenses take a completely different approach by maintaining a cushion of fluid between the lens and your corneal surface.
The space between a scleral lens and your cornea holds a reservoir of sterile saline solution. This fluid layer bathes your cornea while you wear the lenses, giving your eyes sustained hydration. For people with severe dry eye, this moisture protection can transform how their eyes feel throughout the day.
The reservoir also shields your cornea from the drying effects of air, wind, and indoor heating or cooling systems. This barrier effect helps prevent the evaporation of your natural tears and keeps your ocular surface stable.
The filling solution must be preservative-free, single-use sterile saline specifically approved for contact lens use. Never use multipurpose solutions, cleaning solutions, or any preserved products to fill the bowl of the lens, as preservatives can become trapped against your cornea and cause irritation. Always discard opened saline vials according to the product instructions.
- Bubbles trapped under the lens require removal and reinsertion with fresh saline
- Midday removal, cleaning, and refilling may be needed if vision fogs or debris accumulates
- Do not attempt to top off or add saline to a lens already on your eye
- Fogging can occur from tear debris, mucus, or deposits even with proper filling
Modern scleral lenses are made from highly oxygen-permeable materials that allow your cornea to breathe even though the lens vaults over it. These rigid gas permeable materials maintain their shape while delivering the oxygen your cornea needs to stay healthy.
- The smooth optical surface provides clear, stable vision without distortion
- The rigid material does not dehydrate like soft lenses can
- Custom edge designs ensure comfort where the lens rests on your sclera
- The large diameter distributes weight evenly across a less sensitive area
The central portion of a scleral lens curves in a way that creates clearance, called the vault, above your cornea. We measure this vault carefully during your fitting to maintain a space between the lens and your corneal surface. The goal is to maintain a consistent fluid reservoir depth that supports your eye without creating pressure, though some lenses may settle slightly during wear.
If the vault is too shallow, the lens might eventually settle onto your cornea and cause discomfort. If the vault is too deep, the lens may not fit properly on your sclera. Your eye care provider uses specialized imaging to find the ideal balance for your unique eye shape.
Signs You May Need Scleral Lenses for Dry Eye
Severe dry eye often causes more than just occasional dryness. You might experience burning, stinging, or a gritty sensation that feels like sand in your eyes. Many people also notice excessive tearing as their eyes try to compensate for dryness, along with redness and light sensitivity.
- Blurred vision that improves temporarily when you blink
- Difficulty keeping your eyes open comfortably
- Eye fatigue that worsens as the day goes on
- Discomfort when reading, using screens, or being outdoors
Most people with dry eye start with artificial tears, prescription eye drops, or treatments like warm compresses and lid hygiene. If you have tried multiple approaches without adequate relief, scleral lenses might offer the next level of care. These lenses may be recommended when your symptoms interfere with work, driving, or daily activities despite using other treatments.
Some patients continue using their prescription dry eye medications while wearing scleral lenses for the best combined effect. Others find that scleral lenses reduce their need for drops throughout the day. Your response to treatment helps guide our recommendations.
Scleral lenses often fit into the treatment plan alongside other advanced therapies. Your care may also include anti-inflammatory medications, punctal occlusion to conserve tears, treatments targeting meibomian gland dysfunction, autologous serum tears, or moisture chamber eyewear and exposure management. The combination of approaches depends on the specific causes and severity of your dry eye.
Beyond general dry eye disease, certain corneal conditions especially benefit from the protection scleral lenses provide. People with keratoconus, corneal ectasia (a bulging or thinning of the cornea), or irregular corneas often find that scleral lenses improve both comfort and vision. These lenses can also help after corneal transplants or refractive surgery complications.
Conditions like Stevens-Johnson syndrome, graft-versus-host disease, and Sjogren's syndrome frequently cause severe dry eye with corneal surface damage. The constant moisture from scleral lenses supports healing and protects the compromised corneal surface.
Severe ocular surface disease often requires management of multiple factors even when scleral lenses improve comfort. Controlling lid margin disease, reducing inflammation, and managing exposure remain important parts of your overall treatment plan.
Several factors increase your risk of developing dry eye severe enough to need scleral lenses. Aging reduces tear production naturally, and women going through menopause often experience worsening symptoms. Autoimmune diseases can attack the glands that produce tears or the oils that prevent tear evaporation.
- Long-term contact lens wear that has damaged your corneal surface
- Environmental exposure to wind, smoke, or very dry climates
- Medications like antihistamines or antidepressants that reduce tear production
- Incomplete eyelid closure that allows your cornea to dry out
- Previous eye surgery that affected your corneal nerves or tear film
While scleral lenses help many people with severe dry eye, certain situations require careful evaluation or may make scleral lenses less suitable. Active eye infections, uncontrolled eyelid inflammation, or severe allergies need to be managed before lens fitting. Handling limitations, reduced ability to perform detailed hygiene routines, or living situations without access to clean supplies can make safe lens wear more challenging.
Some corneal conditions require extra monitoring when scleral lenses are considered. Reduced corneal sensation or neurotrophic corneas may not signal problems as readily, so more frequent follow-up is essential. Low corneal endothelial cell counts or conditions like Fuchs dystrophy require careful assessment of oxygen delivery. Significant conjunctival scarring can make fitting more complex, and some patients may need specialized designs or materials.
The Evaluation and Fitting Process
Your first visit involves a comprehensive eye examination and a detailed discussion of your dry eye symptoms and medical history. Our eye doctor will ask how long you have had symptoms, what treatments you have tried, and how dry eye affects your quality of life. We also review any systemic conditions or medications that might contribute to your symptoms.
After understanding your needs, we explain how scleral lenses work and what you can expect from the fitting process. We discuss the time commitment for learning insertion and removal, the cleaning routine, and the follow-up schedule. This conversation helps ensure scleral lenses align with your lifestyle and goals.
Fitting scleral lenses requires precise measurements of your eye shape and size. We use specialized instruments to map the curvature of your cornea and sclera in three dimensions. These measurements guide the custom design of your lenses.
- Corneal topography to map the front surface contours
- Optical coherence tomography to measure vault clearance and assess limbal alignment
- Slit lamp examination to assess your ocular surface health
- Tear film analysis to understand your specific type of dry eye
- Measurement of your scleral shape and any asymmetries
Based on your measurements, we select initial trial lenses that should come close to your ideal fit. We evaluate how each lens sits on your eye, checking the vault over your cornea and the landing zone, the area where the lens edge rests on your sclera. Small adjustments to the diameter, vault depth, and edge design can make a significant difference in comfort and performance.
Every eye is unique, so your lenses are customized to match your individual anatomy. We may order several sets of trial lenses before arriving at the final prescription. This careful process takes time but ensures you receive lenses that work well for your specific needs.
Once we place trial lenses on your eyes, you will wear them in our office for a period of time so we can assess how they settle. We check the fluid reservoir depth, look for any areas where the lens might touch your cornea, and evaluate your comfort level. We also examine the scleral landing zone to ensure even, gentle contact without blanching (whitening from excess pressure) or discomfort.
After the lenses settle, we use special imaging to view the space between the lens and your cornea. If adjustments are needed, we modify the lens parameters and order new trials. This step-by-step refinement continues until we achieve an optimal fit that you can wear comfortably for extended periods.
Daily Use: Inserting, Removing, and Caring for Your Scleral Lenses
Inserting scleral lenses is different from putting in regular contact lenses because you must fill them with sterile saline solution first. We teach you to hold the lens like a small bowl, fill it to the brim with preservative-free saline, and then bring it to your eye while bending forward. Avoid any water exposure during this process and handle your lenses only with clean, dry hands. This technique requires practice but becomes easier with repetition.
Most people use a small stand or holder to stabilize the filled lens before application. You will need to keep your head tilted down as you apply the lens so the saline does not spill out. Once the lens touches your eye, you can stand upright and the lens will settle into position.
After inserting the lens, check for any bubbles trapped under the lens by looking down and then up. If you notice a bubble, you will need to remove the lens, refill it with fresh saline, and reinsert it. Bubbles can interfere with vision and comfort, so it is important to start with a clear, bubble-free reservoir.
Removing scleral lenses requires a gentle technique to avoid any trauma to your eye. We demonstrate how to look in the opposite direction while using your fingertips or a small scleral lens removal plunger placed near the lens edge to break the suction seal. The lens should then slide off your eye easily.
- Always wash and dry your hands thoroughly before touching your lenses
- Work over a clean towel or soft surface in case you drop a lens
- Never try to pinch or pull the lens directly off your cornea
- If the lens feels stuck, add a drop of saline to help break the seal
- If you cannot remove the lens after several attempts, stop and contact our office or urgent eye care
After you remove your scleral lenses, you should clean them immediately with an approved rigid gas permeable lens cleaner. Rub each lens gently but thoroughly on both sides to remove protein deposits, oils, and debris. Rinse the lenses well with sterile saline before placing them in your storage case.
Your storage case should contain fresh disinfecting solution every day. We may recommend hydrogen peroxide-based systems or other solutions specifically approved for rigid gas permeable lenses. If using hydrogen peroxide, the solution must fully neutralize before you insert the lenses; never put hydrogen peroxide directly in your eye. Never use tap water or solutions designed for soft contact lenses, as these can damage your scleral lenses or increase infection risk. Do not store lenses in saline alone, as saline does not disinfect.
- Never top off old solution; discard and refill with fresh solution daily
- Follow the rub-and-rinse steps your eye care provider recommends
- Avoid any water exposure to your lenses or case
- Replace your lens case every three months or sooner if damaged
- Allow your case to air dry upside down between uses if recommended
Store your scleral lenses in a clean case filled with the appropriate disinfecting solution whenever you are not wearing them. The case itself needs regular care to prevent contamination. Replace your lens case at least every three months, or more often if it becomes cracked or cloudy.
Keep your lenses away from extreme temperatures and direct sunlight when stored. Follow your eye care provider's specific storage instructions, which may involve wet storage with conditioning or disinfecting solution, or in some cases dry storage after proper cleaning. Never rinse your lens case with tap water; keep the case clean and dry between uses according to your care system guidelines. If you will not be wearing your lenses for an extended period, ask for storage instructions to keep them in good condition.
Scleral lenses typically last one to two years with proper care, though some patients may need replacement sooner if deposits build up or the lens becomes scratched. We will examine your lenses at each follow-up visit to check for signs of wear. Changes in your eye shape or prescription may also require new lenses even if the current ones still look good.
- Lenses that develop chips, cracks, or deep scratches need immediate replacement
- Clouding or discoloration that does not clean off indicates the lens has aged
- Changes in comfort or vision quality suggest it may be time for new lenses
Adjusting to Scleral Lenses and Ongoing Care
When you first start wearing scleral lenses, you may notice a mild awareness of the lenses on your eyes, especially at the edges where they rest on your sclera. This sensation usually fades within a few days as you adapt. Your vision might seem exceptionally clear compared to what you experienced with dry eye, though some people take time to adjust to the new clarity.
We recommend gradually increasing your wearing time during the first week rather than immediately wearing the lenses all day. Start with a few hours and add more time each day as comfort allows. If you experience significant discomfort or redness, remove the lenses and contact our office for guidance.
Your first follow-up visit typically occurs within a week of receiving your scleral lenses. We check how the lenses are fitting after you have worn them in real-world conditions and make any necessary adjustments. Additional appointments are usually scheduled at one month, three months, and then every six to twelve months depending on your needs.
During follow-up visits, our eye doctor examines your corneal health to ensure the lenses are helping rather than causing any new problems. We also assess the fluid reservoir depth throughout the day, as lenses can settle slightly over time. Regular monitoring helps catch small issues before they become larger concerns.
In cases of severe ocular surface disease, corneal transplants, or reduced corneal sensation, we may schedule more frequent visits to closely monitor your eye health and lens performance. Your follow-up schedule is tailored to your individual needs and risk factors.
While scleral lenses are very safe for most people, you should know which symptoms warrant a call to our office. New or increasing pain, sudden vision loss, or severe redness are never normal. Discharge, crusting, or light sensitivity that develops while using your lenses may indicate an infection or other complication.
Common issues with scleral lenses include fogging from deposits or debris, corneal swelling from inadequate oxygen delivery, redness at the landing zone from fit issues, and discomfort from solution sensitivity. Less commonly, you might experience conjunctival tissue changes, fluid reservoir problems, or lens surface deposits that interfere with vision. Recognizing these signs early helps us adjust your fit or care routine before complications worsen.
- Persistent fogging of your vision that does not clear when you blink
- Bubbles forming under the lens during wear
- Lenses that become uncomfortable after initially feeling fine
- Redness that appears in a ring pattern where the lens lands on your sclera
- Blurred vision with halos that may suggest corneal swelling
- Eyes that look or feel worse than before you started wearing scleral lenses
Many people wear scleral lenses comfortably throughout the day, though safe wearing time varies based on your individual fit, corneal health, oxygen needs, and ocular surface condition. Your eye care provider will help determine appropriate wearing time for your situation. Some patients comfortably wear their lenses from morning until bedtime, while others need to remove them earlier. Listen to your body and remove your lenses if your eyes start feeling uncomfortable, tired, or your vision becomes foggy.
The oxygen-permeable material allows for daytime wear, but you should give your eyes a break by removing the lenses every night. Extended wear and overnight use increase infection risk. We do not recommend sleeping in scleral lenses unless you have a specific medical indication and your eye care provider has given explicit approval and instructions for overnight wear with appropriate monitoring.
Certain symptoms require immediate attention rather than waiting for your next scheduled appointment. If you develop sudden severe pain, cannot see as well as usual through your lenses, or notice that one eye becomes significantly redder than the other, remove your lenses and contact us right away. Eye infections can worsen quickly, and prompt treatment protects your vision.
Also seek urgent care if you experience trauma to your eye while wearing lenses, if a lens cracks or breaks on your eye, or if you cannot remove a lens using your usual technique. After-hours emergencies should be directed to an emergency eye care provider or emergency room if our office is not available.
Frequently Asked Questions
Scleral lenses manage dry eye symptoms by protecting and hydrating your cornea, but they do not cure the underlying condition. You will still have dry eye when you remove the lenses, and you may need to continue other treatments to maintain your ocular surface health.
Think of scleral lenses as a highly effective tool for controlling symptoms rather than a permanent fix for the disease itself. Most patients continue other aspects of their dry eye treatment plan even while benefiting from the comfort and protection these lenses provide.
We generally do not recommend sleeping in scleral lenses because your eyes need time without any lens to maintain optimal health. Wearing lenses overnight increases the risk of complications even though the material allows good oxygen flow.
In rare cases where a patient has a specific medical need for overnight wear, your eye care provider will provide detailed instructions and closer monitoring. Overnight wear is only appropriate when medically necessary and with explicit professional guidance.
Insurance coverage for scleral lenses varies widely depending on your specific plan and the medical reason for prescribing them. Many medical insurance plans provide some coverage when scleral lenses are medically necessary for conditions like severe dry eye, corneal disease, or post-surgical complications.
Our office can help you understand your benefits and provide the documentation your insurance company may require. Coverage typically differs from routine vision benefits and may be processed through your medical insurance rather than vision insurance.
If you experience dryness symptoms while wearing properly fitted scleral lenses, several factors might be responsible. The saline reservoir may be settling throughout the day and creating less clearance, or you might need a different filling solution.
We can adjust your lens parameters, evaluate your insertion technique, or combine the lenses with other dry eye therapies to improve your comfort. Sometimes midday removal and reinsertion with fresh saline resolves the issue.
With excellent care, scleral lenses usually remain in good condition for one to two years before replacement becomes necessary. Some lenses may last longer, while others might need earlier replacement if they develop deposits, scratches, or changes in shape. Regular professional cleaning at our office and careful daily handling at home help maximize the lifespan of your lenses.
- Lenses that develop chips, cracks, or deep scratches need immediate replacement
- Clouding or discoloration that does not clean off indicates the lens has aged
- Changes in comfort or vision quality suggest it may be time for new lenses
You should avoid exposing your scleral lenses to any water source, including swimming pools, hot tubs, lakes, oceans, and shower water. Water can introduce harmful microorganisms such as Acanthamoeba that can cause serious, difficult-to-treat eye infections.
Remove your lenses before any water activities. If accidental water exposure occurs, remove the lenses, clean and disinfect them thoroughly, and contact our office for guidance, especially if you develop any redness, pain, or vision changes.
Getting Help with Scleral Lenses for Severe Dry Eye
If severe dry eye is affecting your daily comfort and quality of life, we invite you to schedule a scleral lens consultation with our eye doctor. During your visit, we will evaluate your specific condition, discuss whether scleral lenses are appropriate for you, and answer all your questions about the process. Many patients find that scleral lenses provide the relief they have been seeking after other approaches have fallen short.