Scleral Lenses for Severe Dry Eyes
Understanding Scleral Lenses for Dry Eye Disease
Severe dry eye disease can make everyday activities like reading, working at a computer, or even keeping your eyes open feel exhausting and painful. According to a 2025 PLOS ONE study, between 15% and 55% of contact lens wearers experience dry eye symptoms, and scleral lenses have been shown to significantly improve comfort for patients with severe dry eye disease (PLOS ONE, 2025). When standard treatments such as artificial tears, prescription drops, and in-office procedures fail to provide lasting relief, scleral lenses offer an advanced solution that both protects and hydrates the corneal surface throughout the day. At Greenwich Ophthalmology Associates, our specialty contact lens fitters work closely with our dry eye specialists to determine whether scleral lenses are the right option for patients in the greater NY/CT region who are living with persistent dry eye symptoms.
What Are Scleral Lenses and How Do They Work
Scleral lenses are large-diameter, rigid gas permeable contact lenses that vault entirely over the cornea and rest on the white of the eye, known as the sclera. Unlike standard contact lenses that sit directly on the cornea, scleral lenses range from approximately 14.5 to 24 millimeters in diameter. This larger size allows the lens to bridge over the entire corneal surface without touching it. The lens lands gently on the less sensitive scleral tissue, which contributes to improved comfort for patients whose corneas are already irritated or compromised by dryness.
Before insertion, the bowl of the scleral lens is filled with sterile, preservative-free saline solution. Once placed on the eye, this fluid reservoir remains trapped between the back surface of the lens and the front surface of the cornea. This constant bath of saline keeps the cornea hydrated for the entire wearing period, essentially creating a smooth, moist environment that replaces the function of a healthy tear film. For patients with severe dry eye, this continuous hydration is often the single most important benefit of scleral lenses.
Because the lens vaults over the cornea without direct contact, it acts as a physical shield against environmental irritants like wind, dust, and low humidity. The sealed fluid chamber also prevents the rapid tear evaporation that drives many forms of dry eye disease. Patients who experience painful exposure from incomplete eyelid closure or reduced blink rates often find significant relief with scleral lenses because the cornea is no longer exposed to air.
Modern scleral lenses are manufactured from highly oxygen-permeable materials that allow adequate oxygen to reach the cornea even though the lens does not rest directly on it. Advances in gas permeable lens materials over the past decade have made it possible to wear scleral lenses safely for extended daily periods, typically 12 to 16 hours, without risking corneal oxygen deprivation.
Who Is a Good Candidate for Scleral Lenses
Scleral lenses are not typically a first-line treatment for mild dry eye, but they can be transformative for patients whose symptoms have not responded to conventional therapies. If you have tried preservative-free artificial tears, prescription anti-inflammatory drops, punctal plugs, warm compresses, and in-office procedures like LipiFlow or IPL without adequate relief, scleral lenses may be the next step. They are especially valuable when dry eye significantly limits your ability to function at work, drive, or enjoy daily life.
Patients with autoimmune diseases that cause severe ocular dryness are among the strongest candidates for scleral lenses. Conditions such as Sjogren's syndrome, rheumatoid arthritis, lupus, and graft-versus-host disease (GVHD) following bone marrow transplant often produce a level of dryness that topical treatments alone cannot manage. Scleral lenses provide consistent corneal protection that helps preserve vision and comfort in these complex cases.
Severe dry eye frequently coexists with corneal surface damage, scarring, or irregularity. Patients with conditions such as Stevens-Johnson syndrome, chemical burns, neurotrophic keratitis (reduced corneal sensation), or exposure keratopathy from incomplete eyelid closure benefit from the dual function of scleral lenses. The lenses simultaneously hydrate the surface and optically correct the irregular cornea by replacing it with a smooth refractive surface. Patients with keratoconus who also struggle with dryness often find scleral lenses address both concerns at once.
Some patients need contact lenses for vision correction but find that standard soft lenses or even hybrid contact lenses worsen their dry eye symptoms. Because scleral lenses do not rest on the cornea and maintain a fluid cushion, many patients who gave up on contact lens wear find they can comfortably wear sclerals for a full day.
What Vision Problems Can Scleral Lenses Correct
Dry eye disease can cause corneal surface irregularities that glasses and soft contact lenses cannot fully correct. The fluid reservoir beneath a scleral lens fills in microscopic surface imperfections on the cornea, creating a new, smooth optical surface. This is why many patients with severe dry eye notice not only improved comfort but also sharper, more stable vision with scleral lenses compared to any other form of correction they have tried.
Scleral lenses can correct nearsightedness (myopia), farsightedness (hyperopia), astigmatism, and presbyopia. For patients who require vision correction and have dry eye, scleral lenses eliminate the need to choose between comfortable eyes and clear sight. Multifocal scleral lens designs are also available for patients over 40 who need help with both distance and near vision.
Several conditions involve both vision distortion and ocular surface compromise, making scleral lenses an ideal solution. Keratoconus with concurrent dry eye benefits because the lens vaults the cone and hydrates the surface simultaneously. Pellucid marginal degeneration with associated dryness responds well to scleral lens therapy. Post-surgical corneal irregularity following procedures such as LASIK, PRK, or corneal transplant can be addressed with custom scleral designs. Terrien's marginal degeneration, a progressive corneal thinning disorder, also benefits from the stable optics and protection of a scleral lens.
How Scleral Lenses Are Fitted
Fitting scleral lenses for severe dry eye is a specialized process that requires expertise, precision instruments, and patience. The fitting process begins with a thorough assessment of your dry eye severity, corneal health, and overall ocular surface condition. Our team uses advanced corneal topography and tomography to map the shape of your cornea and sclera in detail. We also evaluate your tear film quality, meibomian gland function, and any underlying conditions contributing to your dryness to ensure the lens design addresses your specific needs.
Based on the diagnostic data, our specialty contact lens fitters select an initial trial lens from a diagnostic set. The lens is filled with preservative-free saline and placed on your eye. Using a slit lamp microscope, we evaluate the clearance between the back of the lens and the front of your cornea to ensure adequate fluid reservoir depth. We also check that the lens edges land smoothly on the sclera without pressing too tightly or lifting away. Most patients require two to four fitting visits to optimize the lens parameters before placing a custom order.
Once the ideal fit is determined, the lens specifications are sent to a specialty laboratory where your lenses are custom-manufactured. Each lens is made to your exact measurements, including diameter, base curve, vault height, and prescription power. This level of customization is what allows scleral lenses to perform so effectively for patients with complex corneal and ocular surface conditions.
Because scleral lenses are larger than standard contact lenses, the technique for inserting and removing them is different. We provide hands-on training at your dispensing appointment, walking you through filling the lens with saline, placing it on the eye using a specialized plunger or your fingertips, and removing it safely. Most patients become confident with the process within the first week of wear.
After you begin wearing your scleral lenses, we schedule follow-up visits to assess comfort, vision, corneal health, and fluid reservoir clarity. Over time, adjustments may be needed as your eye responds to the improved hydration. Some patients find their underlying dry eye condition stabilizes with consistent scleral lens wear, while others may continue complementary treatments alongside their lenses for the best results.
Frequently Asked Questions
Most patients with severe dry eye report that scleral lenses are significantly more comfortable than they expected. Because the lens does not touch the cornea and the fluid reservoir keeps the surface continuously hydrated, many wearers describe an immediate sense of relief upon insertion. The rigid lens material may feel slightly different from soft contacts at first, but the adaptation period is typically short, often just a few days to two weeks.
Standard soft contact lenses tend to absorb moisture from the tear film and can make dry eye worse. Rigid gas permeable (RGP) lenses sit on the cornea and may cause discomfort on an already compromised surface. Scleral contact lenses offer a fundamentally different approach by vaulting over the cornea and maintaining a fluid reservoir, making them the preferred contact lens option for moderate to severe dry eye. For patients with milder dry eye and a regular corneal shape, daily disposable soft lenses or hybrid lenses may still be appropriate.
Scleral lens care involves cleaning the lens with an approved rigid gas permeable lens solution after each use, rinsing thoroughly, and storing it in fresh solution overnight. You should never use tap water on scleral lenses due to the risk of microbial contamination. The saline used to fill the lens before insertion must be preservative-free and sterile. We will provide you with specific product recommendations and a daily care routine tailored to your lenses.
Scleral lenses are generally very safe when properly fitted and maintained. Potential issues include fogging of the fluid reservoir during wear, which can temporarily blur vision and is often resolved by removing the lens and refilling with fresh saline. Rarely, an improperly fitted lens can cause pressure on the conjunctival blood vessels or trap debris beneath the lens. Regular follow-up appointments help us identify and address these issues early. Serious complications such as infection are uncommon with good hygiene practices.
Scleral lenses require a greater investment than standard contact lenses because of the specialized fitting process and custom manufacturing involved. The total cost typically includes the fitting evaluation, diagnostic testing, trial lens sessions, the custom lenses themselves, and follow-up visits. While costs vary based on lens complexity and the number of fitting sessions required, many patients find the improvement in comfort and quality of life well worth the investment. Some vision insurance plans offer partial coverage for medically necessary contact lenses, and our team can help you understand your benefits.
With proper care, a pair of scleral lenses typically lasts one to two years before replacement is needed. Over time, the lens surface may develop protein deposits or fine scratches that reduce clarity and comfort despite regular cleaning. Changes in your prescription or corneal shape may also prompt a refit. We recommend annual evaluations to assess lens condition and ensure your scleral lenses continue to perform optimally for both comfort and vision.
Find Relief for Severe Dry Eyes
Living with severe dry eye disease does not have to mean accepting constant discomfort or giving up on clear vision. Scleral lenses have helped countless patients regain the ability to go about their day without the distraction of burning, stinging, or blurred sight. At Greenwich Ophthalmology Associates, our fellowship-trained specialists bring decades of experience in fitting scleral lenses for even the most complex dry eye cases across the greater NY/CT region. If you are ready to explore whether scleral lenses are right for you, we welcome the opportunity to evaluate your eyes and discuss a personalized treatment plan.
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