Scleral contact lenses are a type of hard contact lens that rests on the sclera or white portion of the eye. Scleral contacts are also called “sclerals” or “large diameter gas permeables (GPs).”
When patients have irregular corneas, the scleral contact lens is designed to “vault” over the cornea, in essence forming a new cornea for the patient. This allows for clearer vision than would be achieved in just glasses or a pair of soft contact lenses.
For dry eye patients, the fluid reservoir used to fill scleral lenses provides relief from dry eye symptoms.
Related: See the Best Contacts for Dry Eyes
Some corneal irregularities that would require scleral contact lenses are keratoconus, pellucid marginal degeneration, or post-LASIK ectasia. Scleral contacts can also correct far-sightedness that comes with age (presbyopia) and high-power astigmatisms.
In general, scleral lenses are the most expensive of all the lens types, with costs ranging from $900-$1,500 on average. This high cost is because these lenses are custom fit to your eyes, and they may require frequent follow-up and special testing.
Be prepared to spend extra time learning insertion, removal, and lens care. If you have vision insurance, it may cover a portion of the lenses if there’s a documented medical reason you are being fit in scleral contacts (keratoconus, high prescription, irregular cornea, etc.)
What Are Scleral Contact Lenses?
Contact lenses fall into three categories: hard lenses, soft lenses, and hybrid lenses. Among hard lenses, there are small diameter/corneal GPs and large diameter/scleral GPs.
Corneal GPs are smaller than sclerals (about 9.0-9.5 mm diameter for a corneal GP vs. 13.0-15.0 mm for a scleral), which means that they can tuck under the lid and sometimes cause a sensation of “lens awareness” when the patient blinks. This goes away after a couple of weeks of continued wear.
With the larger diameter scleral lenses, this discomfort is avoided because of the increased lens size and the sclera–which has fewer nerve endings than the cornea.
Your eye care provider determines the lenses’ size; usually, larger-diameter scleral lenses stabilize more readily.
As described above, scleral lenses are large-diameter contact lenses used for patients with irregular corneas or ocular surface disease. These lenses are made of several materials, all of which are designed to have high oxygen transmission. This is a measure of how much oxygen can pass through the materials to reach the eye. Your eye care provider will select the materials to suit your lifestyle and your ocular needs.
One of the most common reasons a patient will wear scleral contacts is keratoconus, a disease that makes the transparent front part of the eye (the cornea) shaped like a cone. Keratoconus results in distorted vision, even with glasses.
Scleral contacts first became available in the 1970s but fell out of use because of the early lenses’ low oxygen transmission. With the recent advent of new materials over the past decade, scleral lenses have become increasingly popular to treat irregular corneas, severe dry eyes, chemical burns, and many other conditions.
How Long Do Scleral Contact Lenses Last?
Unlike soft contact lenses, scleral contacts (and small diameter corneal gas permeable or GP contact lenses) are designed to last for 1-2 years at a time. With proper lens handling and care, which is similar to the handling and care of soft contact lenses, scleral contacts can last longer.
Over time, however, the lenses can become warped. Warpage leads to discomfort and decreased or altered vision. In cases of lens warpage, you’ll have to purchase new scleral lenses from your doctor.
Are Scleral Contacts Comfortable?
Because scleral lenses “vault” over the cornea (which is extremely sensitive) and rest on the sclera (which is significantly less sensitive), they are comfortable for daily use.
Most patients find that they can usually comfortably wear scleral contacts for about 10-14 hours a day. If the lenses ever become uncomfortable or blurry, they can be removed and reinserted with fresh saline solution. Some patients with irregular corneas who cannot tolerate small diameter GPs due to their discomfort may be prescribed scleral lenses to avoid this problem.
If your lenses are uncomfortable or make your eyes red or hurt, return to your prescribing doctor to reassess the fit. Swelling or infections can sometimes change how the lenses fit on your eye. If you experience any new discomfort or light sensitivity, you should meet with your eye doctor to ensure there isn’t an underlying condition that requires treatment.
Can You Sleep with Contact Lenses?
Much like soft contact lenses, scleral lenses should not be slept in like extended wear contacts unless directly discussed with your eye care provider. In cases where patients have severe corneal burns, they may be prescribed overnight scleral lenses to protect the ocular surface. Otherwise, wearing scleral lenses overnight can lead to severe complications in the cornea.
It is essential to remove your lenses and store them in either Clear Care or an approved multipurpose solution recommended by your doctor.
Never rinse or store your scleral contacts in water, and be sure not to bend the edges too hard when cleaning the lenses. Doing so can cause the lenses to crack or break.
How Do You Insert and Remove Scleral Contact Lenses?
To insert scleral lenses, you will need the lenses, saline solution, a small mirror, and a clean lens plunger.
- Wash and dry your hands with a lint-free cloth.
- Place a mirror flat on a clean countertop underneath you.
- Open the vial and place the lens on a clean, plastic plunger.
You can clean the plunger with an alcohol wipe; always ensure it is completely dry before using it on your lenses.
- Fill the lens with saline (or approved) solution.
This is very important and is what makes scleral contacts so comfortable and effective. If the lenses become foggy during the day, remove them to add fresh solution. If this issue persists, it may be an issue with the fit of the contact lenses.
Again, NEVER fill a lens with tap water. Your eyes are sensitive, and water can lead to a serious eye infection, especially if your eye has an abrasion or small cut that you haven’t noticed.
- Hold your upper eyelids with your non-dominant hand, making sure to pin the lashes to the brow bone.
This ensures that your eye is open wide enough. Patients with small eyes may find scleral lens insertion difficult, so it is crucial to keep the eyes as wide as possible to accommodate the larger lens design.
- Looking downward at the mirror, use your dominant hand and the plunger to place the lens on the eye.
Once you feel the saline touch your eye, let go, the lens should adhere to your eye. There will likely be some spillage from the saline, so keep a towel or paper towel handy. Sometimes, large air bubbles can get trapped in the lens and cause feelings of discomfort. As with any lens, if it is uncomfortable—remove it immediately!
Here’s a great video about insertion using three fingers or the “tripod” method:
Here’s a great video about insertion using the plunger method:
Scleral Contact Lens Removal Instructions
- As always, start with clean, dry hands.
- Look straight ahead.
- Wet the end of the plunger with saline for traction.
- Apply the plunger to the lower 1/3rd of the lens and pull up and out.
When attempting this, try to imagine the motion of a garage door opening and recreate this movement. This also ensures the lenses don’t break or you don’t accidentally hurt your eye when removing the lenses.
Here’s a great video about removal:
Here’s a great video about removal without a plunger:
Dr. Morgan Jones is a Doctor of Optometry (O.D.) completing a residency in ocular disease. She has experience in diabetic research, along with several years of clinical research. Along with being a community outreach leader and an avid mentor and tutor, she enjoys educating outside of clinic. Dr. Jones has a B.A. in Biology from Texas A&M University.