Scleral Lenses

What are scleral lenses?

Scleral lenses are a type of contact lens that you wear on your eyes. Unlike the more common soft contact lenses that mainly rest on the cornea of your eye, scleral lenses are larger and cover more of the eye surface. They extend beyond the cornea and cover parts of the surrounding sclera (the white of your eye).

Scleral lenses are rigid gas-permeable (RGP) lenses — sometimes known as “hard” lenses — meaning they hold their shape, but oxygen can still pass through them. The center disk of the lens “vaults” (jumps) over the cornea and doesn’t touch the corneal surface at all. The small gap between the cornea and the inner surface at the center of a scleral lens can hold saline or another liquid, which is there to cover your cornea.

The upper and lower edges of scleral lenses actually sit underneath your eyelids, so there’s very little risk of them falling out or something getting underneath them. And because the sclera isn’t as sensitive as the cornea, you’re less likely to notice them once they’re in.

Why are scleral lenses used?

Eye specialists prescribe scleral lenses for many diseases. These include managing problems on the surface of your eye itself and eye symptoms from other conditions. And scleral lenses can sometimes correct vision in ways that soft contact lenses can’t.

These characteristics of how scleral lenses work make them ideal for treating:

• Corneal diseases, especially corneal ectasia conditions like pellucid marginal degeneration and bulging or cone-shaped cornea (keratoconus).
• Severe refractive errors.
• Eye surface conditions due to other causes, including graft vs. host disease (GvHD), Stevens-Johnson syndrome or multiple types of keratitis.
• Severe dry eye.
• Scarring or corneal damage from injuries.
• Disorders that affect your eyelid or the orbit of (the area surrounding) your eye.
• Conditions that require applying medication to your eye surface and keeping it there.

How common are scleral lenses?

Scleral lenses accounted for 7% of all contact lens fittings internationally in 2023.

What are the advantages of scleral lenses?

Scleral lenses can do things that other types of lenses can’t. The most important advantages include:

• They have greater vision correction capabilities. Soft contact lenses have limits on how strong they can be, meaning they can’t always correct more severe refractive errors. Scleral lenses can help with more severe refractive errors. People also commonly describe RGP lenses like scleral lenses as providing clearer, sharper vision.
• They don’t move as easily as smaller contacts. Scleral lenses have edges that sit underneath your eyelids. That keeps the lenses securely in place.
• They offer greater surface coverage. Scleral lenses cover a larger section of your eye surface. Greater coverage means greater protection, which is ideal when you have certain types of eye issues.
• Their design holds fluid against your eye surface. The gap between the inside of a scleral lens and the front of your cornea is tiny, but it holds saline or other medicated solutions. In effect, this keeps your cornea immersed, which can help with a variety of conditions and issues.
• They treat conditions that might otherwise need surgery. More severe forms of keratoconus often need surgery to correct. But scleral lenses can sometimes be an earlier alternative and help you avoid (or at least delay) surgery.

What are the risks or drawbacks of scleral lenses?

Scleral lenses have some drawbacks, but they’re usually minor and manageable. The most common drawbacks and issues include:

• They take time to get used to. Some people find it takes longer to get used to scleral lenses. That includes putting them in and removing them, taking care of them and feeling comfortable with wearing them. Early on, you might need to wear the lenses for a short time and gradually wear them for longer and longer as you get used to them.
• They often cost more. Scleral lenses are a little more expensive because they require more specialized fitting and manufacturing. But advances in manufacturing and fitting methods have helped lower the cost in recent years.
• They need a little bit of upkeep when worn. Particles and other debris can get stuck in the tear fluid that fills the space between the front of your cornea and the back of the lens. Most people need to take the lens out at least once per wearing, clean it and then put it back in.
• The manufacturing and fitting process usually takes multiple steps. Getting a good pair of scleral lenses is rarely a one-and-done process. Most people go through two or three attempts to get a lens that fits just right. And many lenses come with warranties that cover the cost of making a new pair within a certain timeframe just in case this happens.

When should I see my healthcare provider?

If you have an underlying condition that the scleral lenses treat, your eye care specialist will recommend regular visits to monitor the treatment effectiveness. If you wear scleral lenses to correct vision only, your provider will also give you a recommended follow-up schedule.

You should also tell your provider if you notice any of the following:

• Changes in how well your scleral lenses fit.
• Changes in how well you see through the lenses.
• If your lenses frequently move out of place.
• If your lenses are difficult to remove.

It’s also vital that you stop using the lenses if you notice recurring discomfort or pain. Discomfort is a sensation that’s not quite painful but is more than just something being uncomfortable because it’s new. While scleral lenses might feel a little uncomfortable or odd early on, discomfort or pain aren’t things you should expect or try to endure. If your scleral lenses cause discomfort or pain, take them out as soon as possible and talk to your eye specialist before using them.

How long do scleral lenses last?

Scleral lenses should last one to two years. Some may last longer, but this isn’t common. Your eye specialist can tell you more about the expected lifetime for your lenses based on the brand, material and your specific needs and circumstances.

How long can you wear scleral lenses in a day?

It varies. Some people may not be able to wear scleral lenses for more than a few hours, especially when they first start. But people can often work their way up to wearing them for 10 or more hours. Your eye specialist can tell you more about your lenses’ maximum daily wear time.

It’s also common to need to take the lenses out during the day and clean them before putting them back in, so you shouldn’t be afraid to do so. Taking the time to clean them may make it easier to wear your lenses longer. And when you clean your lenses, be sure to use only the recommended solution or fluid. You should NEVER use tap water or saliva (spit). Using something other than the cleaning solution your provider recommends can damage your lenses, cause an eye infection or have other negative effects.

How do I insert scleral lenses?

Inserting scleral lenses works differently from smaller contact lenses. To put them in, do the following:

1. First, make sure you wash your hands. Hand hygiene can help you avoid eye infections or other issues.
2. Hold the lens open-side-up (like a bowl) and fill it with saline or another type of recommended fluid (your eye specialist can tell you about the kinds you should use). You always want to overfill the lens. If you don’t, you might not have enough fluid in the gap and leave an air bubble between your eye and the lens. If that happens, you need to remove the lens and start over.
3. Hold the filled lens using a “tripod” method, balancing the lens on the tips of the index and middle fingers and thumb of your dominant hand.*
4. Bend forward and pull your chin into your chest so your face is parallel to the floor. You need to do this so the fluid in the lens doesn’t spill as you’re putting the lens in your eye.*
5. Using the index finger of your nondominant hand, pull your upper eyelid upward to open your eye wider.*
6. Using the middle finger on your dominant hand, pull your lower eyelid downward to widen your eye further.*
7. Bring the lens directly upward to your eye. Be careful not to spill the fluid.
8. Once you feel the lens resting against the surface of your eye, let go of the upper eyelid you were holding with your nondominant hand’s index finger.* The eyelid should close over the upper edge of the scleral lens. Don’t move the index finger of your dominant hand yet.
9. Remove the middle finger of your dominant hand from your lower eyelid to let that eyelid close over the lower edge of the scleral lens.*
10. Once you’re sure the lens is secure with its upper and lower edges under your eyelids, you can pull your index finger away and stand up straight. You may want to have a tissue handy to wipe up any excess fluid.
11. Make sure you don’t see a gap or air bubble in the fluid in the lens. If you see either, you’ll need to remove the lens, refill it with fluid and put it in again.
12. Repeat the above process exactly as listed above with your other eye.

*Some people prefer to use special applicator-type devices that act like a handle with a bowl-shaped platform at the top. The scleral lens sits atop the platform, open-side-up. If you’re using one of these, these are steps where you’ll use the fingers of your off-hand only, instead of using fingers from both hands for the upper and lower eyelids.

Your eye specialist will help you practice this process early on during the fitting of your lenses. Don’t hesitate to ask them for tips or help learning how to do this. With a little practice, you should find it easy to manage in no time.

A note from Cleveland Clinic

Scleral lenses might seem intimidating at first because they’re noticeably wider than standard contact lenses. But they’re designed that way, and the size and shape are key features that make them useful. Your eye specialist can help you understand how to put these lenses in, take them out and maintain them.

Once you’re used to your scleral lenses, you should barely notice you have them on (or you might not notice them at all). Rather than focusing on how your eyes feel, you can turn your gaze to what you care most about, and let the lenses do their job of improving your vision and eye health.