Scleral Lenses
What Are Scleral Lenses?
Standard soft contact lenses rest directly on your cornea, the clear front surface of your eye. Scleral lenses are much larger and sit only on the sclera, avoiding any contact with the sensitive corneal tissue. This design makes them ideal for eyes with irregular shapes or sensitivity that cannot tolerate smaller lenses.
The size difference is significant. While typical soft lenses measure about 14 millimeters in diameter, scleral lenses can range from 15 to 24 millimeters. This larger design provides greater stability and reduces the risk of the lens shifting or falling out during daily activities.
The unique vault design creates a protective space between the back surface of the lens and your cornea. We fill this space with preservative-free saline solution before you insert the lens each day. This fluid reservoir serves multiple purposes throughout your wearing time.
- The saline layer bathes your cornea continuously, keeping it moist and comfortable
- The vault eliminates friction that might damage fragile or irregular corneal tissue
- The fluid-filled chamber smooths out any irregularities in corneal shape
- This design creates a new optical surface that can significantly improve vision quality
Many patients turn to scleral lenses after struggling with other correction methods. Because these lenses vault over the cornea completely, they can correct vision problems that glasses and standard contacts cannot address. The large diameter also means they remain centered on your eye more reliably than smaller lenses.
The fluid reservoir provides continuous moisture while worn for eyes that cannot produce enough tears. We often recommend this option for patients who have tried multiple types of contacts without success. The stable fit and consistent optical surface deliver sharp vision even when the cornea itself is damaged or misshapen.
Who Should Consider Scleral Lenses?
Keratoconus causes your cornea to thin and bulge outward into a cone shape instead of maintaining its normal rounded curve. This progressive condition makes glasses ineffective and standard contacts uncomfortable or unstable. Scleral lenses vault over the irregular cone and create a smooth optical surface that restores clear vision.
We also fit scleral lenses for other corneal irregularities, including pellucid marginal degeneration and corneal ectasia. The large diameter design accommodates steep or uneven areas that smaller lenses cannot cover properly. Many patients notice clearer vision once we achieve the right fit.
Scleral lenses improve vision but do not stop keratoconus from progressing. Corneal collagen cross-linking is a separate treatment that may slow or halt progression. We will discuss whether cross-linking is appropriate for you.
Severe dry eye can make contact lens wear impossible with traditional options. The constant moisture provided by the saline-filled vault in scleral lenses protects your cornea from exposure throughout the day. This barrier prevents evaporation of your natural tears and supplements them with fresh saline.
- Patients with Sjogren's syndrome often find relief with scleral lenses
- People with graft-versus-host disease may benefit from the continuous corneal bathing
- Those with severe meibomian gland dysfunction can protect their corneas while treating the underlying cause
- Individuals with incomplete eyelid closure gain protection from corneal exposure
Scleral lenses are one part of a dry eye plan. Continue prescribed treatments for eyelids, tear quality, inflammation, and any systemic conditions.
Scarring from infections, injuries, or chemical burns can leave the cornea with an irregular surface. Scleral lenses mask these irregularities optically and may provide vision that cannot be achieved with any other method. We fit many patients after corneal transplant surgery once the graft is stable and your surgeon has cleared lens wear.
Scleral lenses can improve vision after radial keratotomy or LASIK when changes are stable. Your eye doctor will advise on timing. These lenses improve vision and comfort and are not a substitute for medical care during early healing.
Very high degrees of nearsightedness, farsightedness, or astigmatism sometimes exceed the range that standard contact lenses can correct effectively. Scleral lenses can be manufactured with stronger prescriptions and more precise corrections. The stable position on your eye supports stable alignment for astigmatism correction.
Custom manufacturing allows us to create lenses for nearly any prescription strength. High Dk materials maximize oxygen delivery, but total oxygen reaching the cornea also depends on lens and fluid reservoir thickness. Your fit balances clarity with corneal oxygen needs.
If you have tried multiple types of contact lenses without success, scleral lenses may offer a solution. Many people who cannot tolerate standard lenses due to discomfort, dryness, or poor fit find scleral lenses completely different. The lack of contact with the cornea eliminates many common sources of irritation.
- Soft lenses that move excessively or fall out frequently are replaced by stable scleral designs
- Rigid gas-permeable lenses that feel scratchy may have been touching sensitive corneal areas
- Lenses that dry out quickly are replaced by the moisture-rich scleral vault design
- Problems with lens awareness often resolve because scleral lenses tuck under the eyelids
Depending on your goals and corneal shape, alternatives may include corneal rigid gas-permeable lenses, hybrid lenses, custom soft lenses for keratoconus, or piggyback systems. We will review these options with you.
The Scleral Lens Fitting Process
Before we can fit scleral lenses, our eye doctor performs a thorough examination of your eye health and vision needs. We evaluate the front surface of your eye, measure your current prescription, and assess your tear production. This baseline information helps us determine if scleral lenses are the right choice for your situation.
We also discuss your daily activities, visual goals, and any previous contact lens experience. Your lifestyle affects which lens design and wearing schedule we recommend. The examination typically takes longer than a routine eye exam because we gather detailed measurements that guide the fitting process.
Advanced imaging technology allows us to map the unique shape of your entire front eye surface. Corneal topography creates a detailed three-dimensional map showing even tiny variations in curvature. This information is essential for designing a lens that vaults properly over your specific corneal shape.
- Scleral topography measures the shape of the white part of your eye where the lens lands
- Optical coherence tomography may be used to measure the height of the vault during fitting
- These measurements are sent to the laboratory to manufacture your custom lenses
- Digital imaging eliminates much of the trial and error from older fitting methods
During your fitting appointment, we insert diagnostic lenses to assess the fit and your initial comfort level. We evaluate how the lens sits on your eye, check the vault clearance over your cornea, and look for any pressure points. You will wear the trial lens for a period while we observe how it behaves with blinking and eye movement.
We use specialized instruments to view the cross-section of the lens on your eye and measure the fluid layer thickness. The goal is to achieve adequate clearance without excessive vault that might reduce oxygen transmission. We also assess your vision with the trial lens to estimate your final prescription.
Achieving the perfect scleral lens fit usually requires several appointments. Your first custom lenses may need adjustments based on how they perform during all-day wear. We modify the landing zone, vault height, or optical prescription as needed to optimize both comfort and vision.
Each adjustment brings you closer to the ideal fit that you can wear comfortably for extended periods. We evaluate your lenses after you have worn them for several hours to see how they settle on your eye. Most patients require two to four fitting visits before we finalize the design, though complex cases may need more appointments.
Using and Caring for Your Scleral Lenses
Before insertion, you must fill the bowl of the lens completely with preservative-free saline solution. We teach you to hold the lens stable while you bring your eye down to meet it, either over a mirror on a table or using a specialized insertion tool. The saline must fill the entire vault with no air bubbles trapped inside.
- Clean your hands thoroughly and dry them with a lint-free towel before handling lenses
- Fill the lens bowl to the brim while holding it level in a special holder or on your fingertip
- Position your eye directly over the lens and lower it onto the saline surface
- The lens should attach to your eye by suction as you raise your head upright
- Check in a mirror to ensure the lens is centered and no bubbles are visible beneath it
Use only sterile, preservative-free saline approved for scleral lenses. Do not use multipurpose disinfecting solutions, tap water, or homemade saline in the lens bowl. Discard unit-dose saline after use and follow directions for any multi-dose bottles.
Removing scleral lenses differs from removing standard contacts because you cannot simply pinch the lens between your fingers. We recommend using a small removal plunger designed specifically for scleral lenses. You place the plunger on the lower edge of the lens and gently rock it to break the seal, then lift the lens away from your eye.
Some patients learn to remove lenses by blinking while manipulating the eyelid to catch the edge. However, the plunger method is safer and reduces the risk of accidentally scratching your eye. We demonstrate both techniques during your training and help you find the method that works best for you.
- Rinse and air-dry the removal plunger daily, replace it regularly, and never share it
- Aim the plunger near the lower edge of the lens, not over the cornea
- Gently press on the white of the eye next to the lens to break the seal before lifting
After removing your lenses each day, rinse them with preservative-free saline to wash away mucus and debris. Place a few drops of approved cleaning solution on each side of the lens and gently rub with your fingertip using a back-and-forth motion. Thorough mechanical cleaning removes protein deposits and other buildup that can cloud your vision or cause irritation.
After cleaning, rinse the lenses again with saline and place them in fresh disinfecting solution in your lens case. The lenses must soak for the minimum time specified by the solution manufacturer to ensure proper disinfection. We will recommend specific products that are compatible with your lens material and safe for your eyes.
- Always perform the rub and rinse step even if your solution is labeled no-rub
- If you use a hydrogen peroxide system, never top off and allow full neutralization before wear
- Saline is not a disinfectant. Do not store lenses in saline overnight
Always store your scleral lenses in a clean case filled with fresh disinfecting solution. Never reuse solution from the previous day, as this can lead to contamination and serious eye infections. Replace your lens case at least every three months, or more often if it becomes cracked or cloudy.
- Keep your lens case in a clean, dry location away from the bathroom sink splash zone
- Allow the empty case to air dry completely each day after you insert your lenses
- Never use tap water, saliva, or any non-sterile liquid to store or rinse your lenses
- Bring your lenses to follow-up appointments so we can inspect them for damage or deposits
- Do not swim, shower, or use hot tubs while wearing your lenses. Avoid any water contact with lenses or cases
Avoid exposing your lenses to water and manage cosmetics to reduce contamination.
- Insert lenses before applying makeup. Remove lenses before removing makeup
- Avoid oil-based products around the eyes and aerosols while lenses are in
- Wash hands with non-moisturizing, fragrance-free soap before handling lenses
- Do not wear lenses when swimming, showering, or in hot tubs
When you first receive your scleral lenses, we recommend building up your wearing time gradually. Start with just a few hours on the first day and increase by one to two hours each day as comfort allows. This gradual approach helps your eyes adapt to the new lenses without becoming overly fatigued.
Most patients can eventually wear scleral lenses for 12 to 16 hours daily once fully adapted. However, your individual wearing time depends on your eye health and the reason you need scleral lenses. Some conditions may require shorter wearing periods or scheduled breaks during the day to maintain optimal eye health. If fogging develops, remove the lens midday, rinse the lens, refill the bowl with fresh preservative-free saline, and reinsert.
What to Expect: Adaptation and Ongoing Care
The first few days with scleral lenses involve learning the insertion and removal techniques until they become routine. You may need several attempts to insert the lenses successfully at first, but the process becomes quicker with practice. We encourage you to contact our office if you struggle with handling after the first few tries.
Your vision may fluctuate slightly during the first week as your eyes adjust to the new lenses. Some patients notice their vision is sharpest right after insertion and becomes slightly cloudier after several hours. This often improves as your tear film stabilizes and the lenses settle into their optimal position.
Initial lens awareness is normal when you first start wearing scleral lenses. You might feel the edges of the lenses under your eyelids, especially when blinking. This sensation typically decreases significantly within the first few days and resolves completely within one to two weeks for most patients.
- Mild redness of the white part of your eye may occur initially but should fade within days
- A small amount of mucus or debris under the lens may cause blurry spots that clear with removal and reinsertion
- Your eyes might feel tired after wearing the lenses for several hours at first
- Increased tear production or watering is common in the beginning as your eyes respond to the new lenses
Scleral lenses are safe when properly fitted and cared for, but they have risks and limitations. Contact us if you notice any of the following.
- Midday fogging from debris in the fluid reservoir
- Corneal hypoxia or edema with haze or halos, often related to excessive vault or long wear time
- Limbal redness or new blood vessels from low oxygen
- Conjunctival blanching, impingement, or suction marks from a tight landing zone
- Pinguecula irritation or impingement at the edge of the lens
- Conjunctival prolapse under the lens near the limbus
- Infection risk if hygiene or disinfection is inadequate
- Allergic or inflammatory responses such as giant papillary conjunctivitis from deposits
- Scleral lenses improve optics and protect the surface but do not cure underlying disease
We schedule your first follow-up appointment within one to two weeks after you receive your scleral lenses. During this visit, we examine how the lenses are fitting after settling on your eyes and check for any signs of complications. We also assess your comfort level and your ability to handle the lenses independently.
Additional follow-up visits occur at regular intervals during the first months and then annually once your fit is stable. These appointments allow us to monitor your eye health, verify that the vault clearance remains appropriate, and update your prescription if needed. We also check the lenses themselves for scratches, warping, or protein deposits that might affect performance. Many patients with keratoconus or ocular surface disease benefit from follow-up every 3 to 6 months.
Several signs indicate that your scleral lens fit may need modification. If you notice a decrease in wearing comfort, changes in vision quality, or difficulty keeping the lenses centered on your eyes, contact our office for an evaluation. Red marks or indentations on the white part of your eye that persist after lens removal suggest the landing zone may be too tight.
Cloudy vision that appears after several hours of wear is often midday fogging from debris in the fluid reservoir or ocular surface inflammation. Shallow vault can cause corneal touch and staining after removal. Excessive vault can reduce oxygen and lead to halos or haze. Air bubbles under the lens suggest an incomplete saline fill or edge lift. Contact our office to reassess your fit.
Remove your lenses immediately and contact our office if you experience sudden sharp pain, significant vision loss, or intense light sensitivity. These symptoms may indicate a corneal abrasion, infection, or other serious problem that needs prompt attention. Do not reinsert your lenses until our eye doctor has examined your eyes and cleared you to resume wear.
- Severe redness that worsens or does not improve after lens removal requires same-day evaluation
- Discharge from your eyes, especially if colored or thick, may signal an infection
- Persistent foreign body sensation that does not resolve suggests something may be trapped under the lens or you may have a corneal injury
- Rainbow-colored halos around lights or sudden increase in floaters needs urgent assessment
- Painful red eye after any water exposure to lenses or eyes needs urgent evaluation
Frequently Asked Questions
Most patients find scleral lenses more comfortable than standard contacts once they complete the initial adaptation period. The lenses do not touch your cornea, which eliminates the foreign body sensation many people experience with smaller lenses. Some wearers report they forget they have the lenses in their eyes after the first few weeks.
With proper care and handling, scleral lenses typically last one to three years before needing replacement. The rigid gas-permeable material is quite durable and resists tearing. However, protein deposits, scratches, or changes in your prescription or eye shape may require earlier replacement. We monitor lens condition at your regular follow-up visits.
Medical insurance may cover scleral lenses when they are medically necessary for conditions like keratoconus, corneal scarring, or severe dry eye. Coverage varies widely among plans and often requires documentation from our eye doctor explaining why standard lenses are not adequate. Vision insurance alone generally does not provide benefits for specialty lenses, though some plans offer partial allowances toward the cost.
We do not recommend sleeping in scleral lenses except in rare circumstances under specific medical supervision. The lenses can limit oxygen flow to your cornea when your eyes are closed for extended periods. Always remove your lenses before sleeping unless our eye doctor has explicitly approved overnight wear for your particular situation and provided special lenses designed for that purpose.
First, remove your lenses and rinse them thoroughly with preservative-free saline to wash away any debris or irritants. Examine the lenses for damage like cracks or chips that might be scratching your eye. If the redness or irritation persists more than an hour after removal, or if you have pain or vision changes, contact our office rather than reinserting the lenses.
The care routine for scleral lenses follows similar principles to standard rigid lenses but requires the additional step of filling with preservative-free saline before insertion. The insertion and removal process takes more time to learn initially compared to soft contacts. However, many patients find the routine becomes quick and automatic within a few weeks of consistent practice. Most people master insertion and removal within one to two weeks with coaching and practice.
No. Do not expose your lenses to water, including pools, lakes, showers, or hot tubs, due to infection risk.
No. Scleral lenses improve vision by masking corneal irregularities. Treatments like corneal collagen cross-linking may slow or halt disease progression and are considered separately.
Getting Help for Scleral Lenses
If you struggle with vision problems that glasses and standard contact lenses cannot solve, scleral lenses may substantially improve your daily vision and comfort. We provide comprehensive fitting services and ongoing support to help you achieve clear, comfortable vision. Schedule an evaluation with our eye doctor to find out if scleral lenses are right for your unique needs.