Scleral Lenses for Managing Dry Eye Disease

From chronic irritation and blurred vision to excessive tearing, and even damage to the surface of the eye, dry eye disease can disrupt daily functioning.

While artificial tears, medicated eye drops, and lifestyle changes are often the first line of treatment, these approaches don’t always provide enough relief — especially in more severe cases.

What Are Scleral Lenses?

While traditional contacts typically sit directly on the cornea, scleral lenses are designed to vault over the cornea entirely and rest on the sclera, or the white part of the eye, says Reecha Kampani, OD, an optometrist at Cleveland Clinic’s Cole Eye Institute.

“The patient fills the bowl of the lenses with preservative-free saline prior to insertion, and there is a space that is retained with saline between the eye and the lens,” Dr. Kampani says. This is how they’re used to keep eyes protected and moisturized.

“The more important distinction is their function and design. I typically explain to patients that scleral lenses are used more as a long-term therapeutic device when we need to maintain a stable fluid environment over the eye or when the cornea is so irregular that we need to vault over it to improve vision,” Dr. Galor says.

The Therapeutic Value of Creating a ‘Tear Reservoir’

This constant hydration can be especially helpful for people who have dry eye disease or whose eyes are unable to maintain a healthy tear film on their own, says Viola Kanevsky, OD, an optometrist based in New York City and a spokesperson for the American Optometric Association. “When used for dry eye, the lens creates a fluid-filled chamber that bathes the cornea in nutrient-rich saline and prevents exposure,” she says.

Kampani adds that the way the lens aligns with the sclera can keep irritants from getting underneath the lens. “The lens lands outside of the cornea and aligns well with the sclera, preventing dust or other irritants from getting under it,” she says.

Who Is a Candidate for Scleral Lenses?

Scleral lenses are commonly used in conditions that cause an irregularly shaped cornea, such as keratoconus, or with corneal transplants and corneal scarring. But they’re also used to help people with severe dry eye disease and ocular surface disorders, Kampani says.

• Corneal diseases and conditions that cause cornea-shape irregularities
• Other forms of irregularities like astigmatism
• Refractive surgery patients, such as those who have undergone Lasik eye surgery
• Scarring or corneal damage from injuries
• Disorders that affect the eyelid or area surrounding the eye
• Conditions that require applying medication to your eye surface and keeping it there

• Dry eye syndrome
• Stevens-Johnson syndrome (SJS)
• Rheumatoid arthritis
• Graft vs. host disease (GVHD)
• Sjögren’s syndrome

Galor says scleral lenses can be especially beneficial for patients whose eyes struggle to produce or maintain adequate tears. With Stevens-Johnson syndrome, for example, where long-term recovery of the ocular surface may be limited, scleral lenses provide a continuous lubricating environment over an extremely dry and damaged eye surface, she says.

They’re also useful in cases where medication needs to be administered, she says. “The fluid reservoir beneath the lens helps protect and hydrate the cornea throughout the day, and medications can sometimes be added to the reservoir along with preservative-free saline, such as autologous serum tears in selected patients,” she says.

Scleral lenses are not limited to people who already wear contact lenses. “I have many patients who use these lenses for dry eyes who have never used contacts before,” Kanevsky says.

That said, scleral lenses are not the right fit for everyone. Because they require daily insertion, removal, and cleaning, patients need hand-eye coordination and manual dexterity. “Patients with hand tremors, severe arthritis, or young children, for example, will have a much more difficult time,” Kanevsky says.

For many patients, putting on the lenses can initially feel intimidating. Kanevsky says she remembers fitting her first scleral lens more than a decade ago on a patient who had two consecutive corneal transplants.

“The biggest challenge to this day remains overcoming the fear of placing an intimidatingly large object precariously balanced on one’s fingertips, filled with fluid, while hovering facedown over a table or sink all the while praying that it doesn’t go down the drain and it goes in without an air bubble,” Kanevsky says. “Once the patient gets over that steep learning curve, the lenses themselves are truly life changing.”

Patients must also have stable corneal and ocular tissues to tolerate the lenses, Kampani says. If you’ve had a corneal transplant that is stressed or swollen, a scleral lens may not be a good option until the area calms.

The Fitting Process for Scleral Lenses

Eye doctors use specialized imaging tools to evaluate the shape of the cornea and sclera and determine the best lens design for each patient, Kampani says. “This helps identify any anatomical abnormalities that we need to be aware of in order to ensure a proper fit,” she says.

Kanevsky says additional technologies may include:

• Meibomography (visualization of the glands in the eyelids that produce oil for the tears)
• Keratometry (measurement of the corneal curvatures)
• Specular biomicroscopy (visualization and counting of the cells responsible for maintaining eye clarity)
• Anterior segment optical coherence tomography (OCT)

“[These] are some of the tools used to customize and adjust the scleral lens to the patient’s cornea,” she says.

The lenses are typically modified and adjusted over several appointments to improve comfort, fit, and vision. In complex cases, some lenses may even be created using a mold or impression of the eye to generate a 3D model, Kampani says.

Because the fitting process is individualized, it may take several visits before the final lens fit is achieved. “I tell my patients that above all, they need to be patient with themselves and their doctor while they learn, and while the doctor fiddles with the adjustments needed to get the fit just so,” Kanevsky says.

Cost and Maintenance

Scleral lenses can be expensive, especially compared with standard soft contact lenses. According to Kanevsky, the total price — including the fitting process and the lenses themselves — can range from roughly $1,000 to $10,000 per pair depending on the complexity of the fit.

Most scleral lenses last at least one year, though they may last longer if properly maintained, Kampani says.

The Takeaway

• Scleral lenses are specialized contact lenses that vault over the cornea and create a fluid-filled reservoir that helps continuously hydrate and protect the eye surface.
• They are typically used for corneal conditions and severe dry eye disease when standard treatments like artificial tears are not enough to relieve symptoms or support healing.
• While they require a customized fitting process over a few appointments and daily cleaning, scleral lenses can significantly improve comfort, vision, and quality of life for patients.