Scleral Lenses for Dry Eye
For some people with dry eye, conventional contact lenses become uncomfortable or impossible to wear. For others with more significant ocular surface disease, even blinking and everyday activities can become uncomfortable as the corneal surface remains inadequately protected.
Scleral lenses for dry eye offer a very different type of contact lens experience. Instead of resting directly on the cornea, a scleral lens is designed to vault over it and rest on the white portion of the eye. The space between the lens and cornea is filled with preservative-free sterile saline, creating a fluid reservoir over the corneal surface while the lens is worn.
For appropriately selected patients, this combination of ocular surface protection, continuous fluid coverage, and customized vision correction can make scleral lenses an important option when dry eye or ocular surface problems interfere with comfort, vision, or conventional contact lens wear.
At Keratoconus Specialists of Maryland, Dr. Benjamin Azman, OD, provides highly customized scleral lens fitting for patients with complex corneal and ocular surface conditions.
How Scleral Lenses Help Dry Eyes
The feature that makes a scleral lens particularly different from a conventional contact lens is the way it interacts with the cornea.
A conventional soft contact lens sits directly on the corneal surface. For someone with significant dry eye, that interaction may contribute to discomfort, fluctuating vision, limited wearing time, or contact lens intolerance.
A scleral lens works differently.
The lens is larger and is designed to vault over the cornea rather than rest directly on it. Before insertion, the bowl of the lens is filled with preservative-free sterile saline.
Once the lens is placed on the eye, that saline remains between the back surface of the lens and the cornea, forming a fluid reservoir over the corneal surface.
For selected dry-eye patients, this can:
- Continuously bathe the corneal surface in fluid while the lens is worn
- Protect the cornea from direct interaction with the eyelids and surrounding environment
- Provide an alternative for patients who cannot comfortably tolerate conventional contact lenses
- Improve visual stability when an irregular or compromised ocular surface is contributing to fluctuating vision
- Provide vision correction and ocular surface support within the same lens system
This is why scleral lenses can play a unique role for certain patients with significant dry eye or ocular surface disease.
The Fluid Reservoir: What Makes a Scleral Lens Different
One of the defining features of a scleral lens is the fluid reservoir beneath the lens.
Before insertion, the scleral lens is completely filled with preservative-free sterile saline. Because the lens is designed to vault over the cornea, the fluid remains between the lens and corneal surface after the lens is placed on the eye.
Instead of the cornea being directly exposed to the surrounding environment, the front surface of the cornea remains covered by this fluid while the lens is worn.
For patients with dry eye or compromised ocular surfaces, this creates an environment that is fundamentally different from conventional contact lens wear.
The rigid front surface of the scleral lens can simultaneously provide optical correction, meaning the lens may serve two important purposes: supporting the ocular surface while also correcting vision.
Who May Benefit From Scleral Lenses for Dry Eye?
Scleral lenses are not necessary or appropriate for every person with dry eye.
They are generally considered when the patient’s symptoms, ocular surface condition, vision, or contact lens intolerance warrant a more specialized approach.
Patients who may be evaluated for scleral lenses include those who:
- Have significant or persistent dry-eye symptoms
- Cannot comfortably tolerate conventional soft contact lenses
- Experience limited contact lens wearing time because of dryness or discomfort
- Have ocular surface disease requiring additional corneal protection
- Experience fluctuating vision related to an unstable or compromised ocular surface
- Have already tried other approaches without adequate comfort or function
- Need both specialty vision correction and ocular surface support
- Have complex corneal or ocular surface conditions that make conventional lens wear difficult
The underlying cause of the dry eye is important. A comprehensive evaluation may therefore be necessary before determining whether a scleral lens should be considered.
A Patient's Experience With Dry Eye and Specialty Scleral Lenses
For patients with complex dry eye and corneal conditions, finding the right combination of diagnosis, treatment, and specialty lens care can sometimes be a long process.
In this patient’s story, she describes her experience seeking help from multiple doctors before coming to Dr. Benjamin Azman for her keratoconus, dry eye, and specialty scleral lens care.
Scleral Lenses Are Not a Cure for Dry Eye
It is important to distinguish between using a scleral lens to support the ocular surface and treating the underlying cause of dry-eye disease.
Dry eye can have many different causes and contributing factors. Depending on the individual patient, these may involve tear production, tear evaporation, meibomian gland dysfunction, eyelid disease, inflammation, medication, previous eye surgery, systemic conditions, or other ocular surface problems.
A scleral lens does not cure these underlying causes.
Instead, the lens creates a protected, fluid-filled environment over the cornea while it is being worn.
For some patients, scleral lenses may therefore be only one component of their overall care.
Patients who require a comprehensive evaluation and medical treatment of the underlying dry-eye condition can learn more about our affiliated Dry Eye Center of Maryland.
This page is specifically focused on the role of scleral lenses for patients with dry eye and ocular surface disease.
Why Customization Matters for Dry Eye Scleral Lenses
Not all scleral lenses are designed or fit the same way.
A scleral lens must do more than simply vault over the cornea.
The relationship between the lens and the individual eye can influence:
- Comfort
- Corneal clearance
- Lens stability
- Fluid reservoir
- Edge alignment
- Interaction with the conjunctiva and sclera
- Vision
- Overall wearing time
This can be especially important for patients with sensitive or compromised ocular surfaces.
An eye may also be asymmetric. The sclera is not necessarily perfectly round, and previous surgery, ocular surface disease, anatomical differences, or other conditions can make an eye more difficult to fit.
The goal is therefore not simply to determine whether a scleral lens can be placed on the eye.
The goal is to design a lens that works with the individual anatomy and ocular surface while providing the best combination of comfort, protection, stability, and vision possible.
Advanced Custom Scleral Lens Options for Complex Dry Eye
Many patients can do very well with a properly designed custom scleral lens.
More complex ocular surfaces may require a higher level of customization.
Depending on the individual eye, our available scleral lens technologies include:
Custom Scleral Lenses
Individually selected and customized according to the patient’s ocular anatomy, vision, and lens response.
Scan-Based Scleral Lenses
Advanced imaging can map the shape of the ocular surface so that the back surface of the lens can be designed around the individual eye rather than relying only on conventional diagnostic lens fitting. Learn more about scan-based scleral lens technology.
Impression-Based Scleral Lenses
For highly complex or irregular ocular surfaces, impression-based technology can use a physical impression of the eye to create an exceptionally customized lens. This may be useful when conventional scleral designs cannot adequately accommodate the shape of the ocular surface. Learn more about EyePrintPro impression-based scleral lenses.
The most advanced technology is not automatically the best choice for every patient.
The appropriate lens should be based on what the individual eye actually requires.
What If You Already Tried Scleral Lenses for Dry Eye?
Some patients come to us after already trying scleral lenses but being unable to wear them successfully.
They may have experienced:
- Persistent discomfort
- Redness after wearing the lenses
- Pressure or awareness of the lens
- Fogging or cloudy vision during the day
- Fluctuating vision
- Difficulty wearing the lenses for the desired amount of time
- Problems with the lens edge or landing area
- Vision that was not as clear or stable as expected
A previous unsuccessful experience does not necessarily mean that every scleral lens will perform the same way.
Lens diameter, corneal clearance, scleral landing-zone design, edge alignment, lens stability, ocular surface health, and the underlying cause of the patient’s symptoms can all affect the experience.
For difficult cases, advanced imaging or a more customized lens design may provide information and options that were not part of the previous fitting.
Patients who have already struggled with scleral lenses can also learn more about our approach to failed or poorly fitting scleral lenses.
Dry Eye and Contact Lens Intolerance
Dry eye can make conventional contact lens wear increasingly difficult.
A patient who previously wore soft contact lenses comfortably may begin noticing that the lenses feel dry, become uncomfortable earlier in the day, cause fluctuating vision, or can no longer be tolerated for a full day.
For selected patients, changing the way the contact lens interacts with the eye can make a significant difference.
Because a scleral lens vaults the cornea instead of resting directly on it, the corneal surface is separated from the lens by the fluid reservoir.
This does not mean every patient with contact lens intolerance needs a scleral lens. In some cases, identifying and treating the underlying dry-eye condition may allow conventional contact lens wear to become comfortable again.
The first step is understanding why the patient is having difficulty and then determining which approach makes the most sense.
Scleral Lenses for Dry Eye After LASIK or Other Eye Surgery
Some patients develop persistent ocular surface symptoms or contact lens intolerance following LASIK or other eye procedures.
When significant dryness is accompanied by visual symptoms, it is especially important to determine what is causing each problem.
Dry eye can affect visual quality, but post-surgical patients may also have corneal irregularity or optical aberrations that require a different type of correction.
A detailed evaluation can help distinguish between problems related primarily to the ocular surface and those involving the optics or shape of the cornea.
For selected patients, a scleral lens may provide both a protected fluid reservoir over the cornea and customized vision correction.
Patients whose primary concern is distorted or irregular vision following LASIK can also learn more about scleral lenses after LASIK.
Advanced Technology for Scleral Lens Fitting
Successful scleral lens fitting requires careful evaluation of how the lens interacts with the individual eye.
Depending upon the case, Dr. Azman’s evaluation may incorporate advanced diagnostic technology such as:
- Optical coherence tomography (OCT) for detailed evaluation of lens clearance and lens-to-eye relationships
- Corneal topography and tomography when corneal shape is relevant to the patient’s condition or vision
- Advanced ocular surface measurements
- Corneo-scleral mapping for selected scan-based lens designs
- Detailed evaluation of lens stability, clearance, landing and edge alignment
For a patient with dry eye, the objective is not simply obtaining a technically acceptable contact lens fit.
Comfort, ocular surface response, wearing time, visual stability, and the patient’s individual needs all matter.
Scleral Lenses for Dry Eye vs. Scleral Lenses for Keratoconus
The basic physical design of a scleral lens, vaulting the cornea and resting on the sclera, can be useful for very different reasons.
For a patient with dry eye or ocular surface disease, an important benefit may be the protected fluid reservoir maintained over the corneal surface.
For a patient with keratoconus or another irregular corneal condition, the primary objective is often to create a new smooth optical surface that improves vision distorted by the irregular cornea.
Some patients have both ocular surface problems and irregular corneal optics, making both aspects important.
Patients whose primary diagnosis is keratoconus can learn more on our comprehensive Scleral Lenses for Keratoconus page.
Why Patients Travel to Us for Custom Scleral Lens Care
Patients with difficult ocular surface and specialty contact lens problems travel to our Baltimore practice seeking a more individualized approach to scleral lens care.
Our approach includes:
- Specialty contact lens experience – our practice has decades of experience working with difficult contact lens and complex corneal cases.
- Multiple levels of scleral lens customization – including conventional custom, scan-based, and impression-based designs.
- Advanced diagnostic technology – allowing us to evaluate the relationship between the lens, cornea, sclera, ocular surface, and visual system in greater detail.
- Experience with previously unsuccessful lens wearers – including patients who have already tried scleral lenses but remain uncomfortable or dissatisfied.
- Individualized care – lens design is based on the needs of the individual eye rather than assuming one scleral lens approach is appropriate for everyone.
Some patients come to us for their first scleral lens evaluation. Others have already visited multiple providers or tried multiple lens designs and are looking for another evaluation of what may be limiting their comfort or vision.
Our Approach: Understand the Eye Before Designing the Lens
Dry eye is not a single condition, and there is no single scleral lens design that is appropriate for every patient.
Our approach begins by understanding the patient’s symptoms, ocular surface, previous treatments, previous contact lens experience, vision, anatomy, and goals.
For some patients, treating the underlying dry-eye disease may be the priority.
For others, a custom scleral lens may provide an important combination of ocular surface protection, comfort, and vision correction.
And for particularly complex eyes, scan-based or impression-based technologies may provide a level of customization beyond a conventional scleral lens fitting.
The goal is not to prescribe a scleral lens simply because a patient has dry eye. The goal is to determine whether a scleral lens is appropriate and, if it is, design it around the needs of that individual eye.
Schedule a Scleral Lens Consultation
If dry eye or ocular surface problems are making conventional contact lenses difficult to wear — or if you have already tried scleral lenses without achieving the comfort or performance you expected — we would be happy to learn more about your case.
For patients considering traveling to our office, our team can review available previous eye-care records and contact lens information before scheduling your visit and discuss whether our specialty scleral lens services may be appropriate for your situation.
Keratoconus Specialists of Maryland
1427 Clarkview Road, Suite 200
Baltimore, Maryland 21209
(410) 469-7111
Call today to speak with our team about scleral lens options.
Frequently Asked Questions — Scleral Lenses for Dry Eye
Can scleral lenses help with dry eye?
Scleral lenses can help selected patients with dry eye and ocular surface disease by vaulting over the cornea and maintaining a reservoir of preservative-free sterile saline between the lens and the eye. Whether they are appropriate depends on the cause and severity of the dry eye and the health of the ocular surface.
How do scleral lenses help dry eyes?
Unlike conventional contact lenses that rest on the cornea, scleral lenses vault over the corneal surface and hold a fluid reservoir over the cornea while the lens is worn. This can protect and continuously bathe the corneal surface while also providing vision correction.
Are scleral lenses a treatment for every type of dry eye?
No. Dry eye has many possible causes, and scleral lenses are not the appropriate treatment for every patient. A detailed dry eye and ocular surface evaluation may be needed to identify the underlying problem and determine whether scleral lenses should be considered as part of the patient’s care.
Can I wear scleral lenses if regular contact lenses are uncomfortable because of dry eye?
Possibly. Some patients who cannot comfortably tolerate conventional soft or corneal gas-permeable lenses because of ocular surface problems may be candidates for scleral lenses. An examination is needed to determine whether a scleral design is appropriate.
Do scleral lenses cure dry eye?
No. Scleral lenses do not cure the underlying causes of dry eye. They can provide a protected fluid-filled environment over the cornea while worn and may be one component of care for selected patients with significant ocular surface disease.
What is the fluid reservoir under a scleral lens?
Before a scleral lens is inserted, it is filled with preservative-free sterile saline. Because the lens vaults over the cornea, the saline remains between the back surface of the lens and the cornea, creating a fluid reservoir while the lens is worn.
Can scleral lenses help severe dry eye or ocular surface disease?
Scleral lenses may be considered for selected patients with significant dry eye or ocular surface disease, particularly when conventional approaches or contact lenses have not provided adequate comfort or function. The underlying diagnosis and condition of the eye must be evaluated individually.
Can scleral lenses improve both comfort and vision?
They can in appropriate patients. The fluid reservoir can support the ocular surface while the rigid optical surface of the lens can also provide vision correction. The degree of improvement varies according to the underlying condition and the individual eye.
What if I have already tried scleral lenses for dry eye and they were uncomfortable?
A previous unsuccessful scleral lens experience does not necessarily mean every scleral design will perform the same way. Lens diameter, clearance, landing-zone design, edge alignment, stability and the condition of the ocular surface can all affect comfort and performance.
Do you offer advanced custom scleral lenses for difficult dry eye cases?
Yes. Depending on the individual eye, available options can include custom scleral lenses and advanced scan-based or impression-based designs. The appropriate technology is determined after evaluating the ocular surface, anatomy, vision and previous lens experience.
Do you treat the underlying dry eye disease too?
This page is specifically about scleral lenses for dry eye. Patients who need comprehensive evaluation and medical management of the underlying dry eye disease can also be evaluated through The Dry Eye Center of Maryland.
Do you see patients who travel for scleral lens care?
Yes. Patients travel to our Baltimore, Maryland office from outside the local area for specialty scleral lens evaluation and fitting. Available prior eye-care records can be reviewed before scheduling to help us understand the case.