Scleral Lenses for Severe Dry Eye

For people with severe dry eye who haven't found relief from conventional treatments, scleral contact lenses offer a revolutionary solution. These specialized lenses create a protective fluid reservoir over the cornea, providing continuous lubrication and dramatic symptom relief. Understanding how scleral lenses work and whether they're right for you can open the door to life-changing dry eye management.

What Are Scleral Lenses?

Scleral lenses are large-diameter rigid gas-permeable contact lenses that vault over the entire cornea and rest on the sclera (the white part of the eye). Unlike traditional contact lenses that sit directly on the cornea, scleral lenses create a space between the lens and corneal surface. This space is filled with preservative-free saline solution, creating a fluid reservoir that continuously bathes the cornea.

The lens diameter typically ranges from 14-24mm, significantly larger than standard contact lenses (9-10mm). This larger size provides several advantages: the lens doesn't touch the sensitive cornea, it's more stable and less likely to dislodge, and the fluid reservoir provides constant lubrication throughout the day.

How Scleral Lenses Help Dry Eye

The fluid reservoir created by scleral lenses provides continuous moisture to the cornea, protecting it from exposure to dry air and reducing evaporation. This is particularly beneficial for people with severe aqueous-deficient dry eye (insufficient tear production) or exposure keratopathy (incomplete eyelid closure).

The lenses also protect the corneal surface from mechanical irritation caused by blinking, eyelid abnormalities, or environmental factors. For people with damaged corneal surfaces from chronic dry eye, scleral lenses provide a healing environment by maintaining constant moisture and protecting against further damage.

Because scleral lenses rest on the less-sensitive sclera rather than the cornea, they're often more comfortable than traditional contact lenses for people with dry eye. The stable fit means less lens movement and irritation throughout the day.

Who Benefits from Scleral Lenses?

Scleral lenses are particularly beneficial for people with severe dry eye that hasn't responded adequately to other treatments. Ideal candidates include those with Sjögren's syndrome, graft-versus-host disease, Stevens-Johnson syndrome, and other conditions causing severe aqueous-deficient dry eye.

People with corneal irregularities from keratoconus, post-surgical complications, or corneal scarring also benefit significantly. The rigid lens surface corrects vision by creating a smooth optical surface, while the fluid reservoir addresses dry eye symptoms simultaneously.

Those who cannot tolerate traditional contact lenses due to dry eye may find scleral lenses comfortable and wearable for extended periods. People with incomplete eyelid closure (lagophthalmos) benefit from the protective barrier scleral lenses provide.

The Fitting Process

Fitting scleral lenses requires specialized expertise and equipment. The process typically involves multiple appointments over several weeks. Your eye care provider will take detailed measurements of your eye's curvature and dimensions using advanced imaging technology.

Initial diagnostic lenses are selected based on these measurements. You'll wear trial lenses while your provider evaluates the fit, checking for proper vault over the cornea, adequate edge clearance, and appropriate lens movement. The fluid reservoir depth is assessed to ensure optimal corneal hydration without excessive lens thickness.

Custom lenses are then ordered based on the diagnostic fitting. When your lenses arrive, you'll return for final fitting verification and comprehensive training on insertion, removal, and care. Most people master the insertion and removal technique within a few days of practice.

Daily Use and Care

Insertion Process

Inserting scleral lenses requires a specific technique. You'll fill the lens bowl with preservative-free saline solution, then insert the lens while looking down into a mirror. The lens is positioned on the eye using a small plunger or your fingers. With practice, most people can insert lenses in under a minute.

Wearing Schedule

Most people can wear scleral lenses for 12-16 hours daily. Some may need to remove and refill lenses midday if debris accumulates in the fluid reservoir or if the reservoir becomes cloudy. Your eye care provider will recommend an appropriate wearing schedule based on your specific needs.

Cleaning and Maintenance

Daily cleaning with approved rigid gas-permeable lens solutions is essential. Lenses should be stored in a clean case with fresh solution overnight. Regular protein removal treatments help maintain lens clarity. With proper care, scleral lenses typically last 1-3 years before replacement is needed.

Cost Considerations

Scleral lenses are more expensive than traditional contact lenses due to their custom nature and the specialized fitting process. Initial costs typically range from $2,000-$4,000 for both eyes, including fitting fees. Replacement lenses cost $400-$800 per lens.

Many insurance plans provide partial coverage for medically necessary scleral lenses, especially when prescribed for conditions like keratoconus or severe dry eye. Some flexible spending accounts (FSAs) and health savings accounts (HSAs) can be used for scleral lens expenses.

Potential Challenges

While scleral lenses offer significant benefits, they're not without challenges. The insertion and removal process requires manual dexterity and can be difficult for people with arthritis or tremors. The lenses require more maintenance than soft contact lenses.

Some people experience fogging or cloudiness in the fluid reservoir during wear, requiring midday removal and refilling. Others may develop corneal edema (swelling) if the lens fit is too tight or wearing time is excessive. Regular follow-up appointments are essential to monitor for complications and ensure optimal fit.

Life-Changing Relief

For many people with severe dry eye, scleral lenses provide relief that other treatments couldn't achieve. The ability to function comfortably throughout the day without constant eye drops or pain can be truly life-changing. At The Last Optical, we specialize in fitting scleral lenses for complex dry eye cases and can evaluate whether this treatment option is right for you.