Scleral Lenses for Dry Eye

How a scleral lens treats dry eye

Every other dry eye treatment tries to improve the tear film. A scleral lens replaces it. The lens is filled with preservative-free saline before insertion and placed over the eye; because it rests on the sclera and does not touch the cornea, the saline stays trapped beneath it, keeping the cornea immersed for the entire wearing time. The lens also shields the surface from wind, air conditioning and the friction of blinking, and its smooth front surface gives sharp vision even when the cornea beneath is irregular from dryness damage.

Who benefits

• Sjogren's syndrome and other severe aqueous deficient dry eye
• Neurotrophic keratitis, where the protected reservoir helps the surface heal
• Exposure keratopathy from incomplete lid closure or facial nerve palsy
• Graft versus host disease, Stevens-Johnson syndrome and other surface disease
• Severe dry eye after LASIK or other surgery that has not responded to treatment
• Patients whose dry eye has damaged the cornea enough to blur vision, who gain both comfort and clarity

Fitting and learning to use them

The lens is custom designed from imaging of the cornea and the sclera, and refined over a few visits until the vault, the edge and the vision are right. Patients learn to fill and insert the lens with a small plunger and to remove it, which takes a few sessions of practice. Lenses are worn for the waking day, removed at night, and the saline refreshed if it clouds during the day. Cleaning and disinfection are straightforward and are taught at the fitting.

What patients experience

Relief is often immediate, particularly for patients who have been in constant discomfort, and vision usually improves too. The cornea, protected from drying, often heals over weeks, with less staining at follow-up. Scleral lenses are combined with the rest of the dry eye plan, since the surface still needs treatment when the lenses are out.

Cost

Scleral lenses for medical indications are sometimes covered by medical insurance as medically necessary contact lenses, particularly for Sjogren's, graft versus host disease and corneal irregularity. Our team can confirm your coverage; if benefits do not apply, the fitting and lenses are quoted in writing.