The Definitive Guide to Scleral Lens Care: Preserving Your Vision and Comfort

For individuals seeking unparalleled vision correction and comfort, scleral lenses have emerged as a revolutionary solution. These custom-designed, large-diameter contact lenses vault over the entire corneal surface, resting gently on the sclera (the white part of your eye). This unique design creates a fluid-filled reservoir between the lens and the cornea, providing continuous hydration and a remarkably stable optical surface. While the benefits of scleral lenses are profound, their optimal performance and your long-term eye health hinge entirely on meticulous and consistent care. This comprehensive guide will equip you with the knowledge and actionable steps necessary to master scleral lens care, transforming it from a routine task into a vital part of your daily health regimen.

Understanding the “Why” Behind Meticulous Scleral Lens Care

Before delving into the “how-to,” it’s crucial to grasp the fundamental reasons why scleral lens care demands such precise attention. Unlike traditional soft contact lenses, scleral lenses are a significant investment in your eye health. Their specialized design, while offering immense advantages, also presents unique considerations:

Protecting Your Eye Health: The primary goal of proper lens care is to prevent eye infections, inflammation, and other complications. Improper cleaning or storage can introduce harmful microorganisms to the eye, leading to potentially sight-threatening conditions. The fluid reservoir beneath the lens, while beneficial, can also become a breeding ground for bacteria if not meticulously maintained.
Maximizing Lens Lifespan: Scleral lenses are durable but not indestructible. Regular, gentle cleaning and appropriate storage protect the lens material from scratches, deposits, and warping, extending their lifespan and preserving your investment.
Ensuring Optimal Vision and Comfort: Deposits, debris, or a compromised lens surface can dramatically reduce visual acuity and lead to significant discomfort. A clean, well-maintained lens provides the clearest vision and the most comfortable wearing experience.
Preventing Hypoxia and Corneal Stress: While scleral lenses are designed to allow oxygen transmission, neglecting proper cleaning can lead to a buildup of deposits that impede this process. Over time, chronic oxygen deprivation (hypoxia) can negatively impact corneal health.
Maintaining the Integrity of the Fluid Reservoir: The sterile saline solution in the fluid reservoir is critical for corneal hydration and optical clarity. Contamination or improper filling techniques can compromise this vital element.

Understanding these underlying principles elevates lens care from a mere chore to a critical act of self-preservation, fostering a commitment to best practices.

The Essential Toolkit: Gathering Your Scleral Lens Care Arsenal

Before you even touch your lenses, ensure you have all the necessary supplies readily available. Attempting to improvise or rush can lead to errors and contamination. Your essential scleral lens care toolkit includes:

Approved Cleaning Solution: This is your primary weapon against deposits and microorganisms. Always use a cleaning solution specifically recommended by your eye care professional. These typically contain surfactants that break down lipids and proteins.
Approved Disinfecting Solution: This solution sterilizes your lenses, killing any remaining bacteria, fungi, and other pathogens after cleaning. Some solutions combine cleaning and disinfecting properties. Hydrogen peroxide-based systems are often preferred for their preservative-free nature and powerful disinfection, but they require a neutralization step.
Sterile Saline Solution (Preservative-Free): This is paramount for filling the bowl of your scleral lenses before insertion. It provides the fluid cushion between the lens and your cornea. Crucially, it must be preservative-free to avoid irritation and adverse reactions with your eye and the lens material. Never use tap water, distilled water, or any solution not explicitly approved for ophthalmic use.
Scleral Lens Suction Cups/Plungers: You will likely need two: one for insertion and one for removal. These specialized tools are designed to securely grasp the lens without damaging it or your eye.
Clean, Lint-Free Towel: Essential for drying your hands thoroughly before handling lenses and for providing a clean, clear surface on which to work.
Dedicated Lens Storage Case: Your case must be clean, dry, and free from any cracks or damage. Many solutions come with their own cases, which are often specifically designed to work with that particular solution.
Small Mirror (Optional but Recommended): A small, illuminated mirror can greatly assist with precise insertion and removal, especially when you are first learning.
Travel-Sized Kit (for on-the-go convenience): A compact version of your essential supplies is invaluable for maintaining your care routine while away from home.

Always check the expiration dates on all your solutions and discard them promptly once expired. Never “top off” old solution with new; always empty the case completely and refill with fresh solution.

The Art of Insertion: A Step-by-Step Guide for Flawless Application

Inserting scleral lenses can seem daunting at first due to their size, but with practice and the right technique, it becomes a smooth, almost effortless process. Patience and a calm demeanor are key.

Preparation is Paramount:

Wash Your Hands Thoroughly: This is non-negotiable. Use mild, unperfumed soap and warm water. Lather for at least 20 seconds, ensuring you clean between your fingers, under your nails, and up to your wrists. Rinse thoroughly and dry your hands completely with a clean, lint-free towel. Residual soap or lint can irritate your eyes or contaminate the lenses.
Set Up Your Workspace: Choose a clean, well-lit area, preferably over a flat, hard surface like a table, not a sink. If working over a sink, ensure the drain is plugged to prevent accidental loss of a lens. Place your clean towel on the surface.
Prepare Your Lens Case and Solutions: Open your sterile saline solution. Ensure your insertion plunger is clean and ready.

The Insertion Process:

Remove the Lens from the Case: Carefully remove one lens from its storage case using your index finger and thumb, or the provided small suction cup (often used for removal but can be gently used for picking up the lens). Be gentle; avoid squeezing or bending the lens aggressively.
Inspect the Lens: Hold the lens up to the light. Check for any chips, cracks, debris, or a “taco” shape (which indicates it’s inside out, though less common with sclerals). The lens should be perfectly clear and bowl-shaped. If it appears damaged or dirty, do not insert it. Reclean or discard if necessary.
Place the Lens on the Insertion Plunger: Place the bowl of the lens face-up onto the larger end of your insertion plunger. Ensure the lens is centered and securely seated.
Fill the Lens Bowl with Saline: This is a critical step. Slowly fill the entire bowl of the lens with preservative-free sterile saline solution until it forms a perfectly convex meniscus (a dome-like shape) that just slightly overflows. The goal is to avoid trapping air bubbles between the lens and your cornea. Air bubbles can cause discomfort, blurry vision, and even corneal drying.
- Concrete Example: Imagine a perfectly filled cup of water, where the water is slightly mounded above the rim but not spilling excessively. That’s the ideal meniscus.
Position Yourself: Stand or sit comfortably in front of a mirror. Lean your head forward so your face is parallel to the floor, looking directly down at the mirror. This posture helps prevent the saline from spilling out of the lens.
Prepare Your Eye: Use the fingers of your non-dominant hand (the hand not holding the plunger) to firmly hold your upper eyelid against your brow bone. Use the fingers of your dominant hand (the hand holding the plunger) to pull down your lower eyelid. You need to create a wide opening to facilitate insertion without your eyelids touching the lens prematurely.
Insert the Lens: While looking straight down at the mirror, bring the plunger with the filled lens directly towards your eye. Keep both eyes open and focused. Slowly and steadily, bring the lens into contact with your eye. You should feel a gentle suction as the lens seats itself.
- Concrete Example: Think of it like a suction cup attaching to a smooth surface. There’s a slight “give” as the air is expelled and the lens adheres.
Release the Plunger: Once the lens is securely on your eye, gently twist or tilt the plunger to break the suction and release it. If the lens doesn’t release immediately, try a very slight side-to-side motion. Do not pull the plunger straight out forcefully, as this can dislodge the lens.
Check for Bubbles and Comfort: Blink several times gently. Look in the mirror for any large air bubbles trapped beneath the lens. Small, peripheral bubbles that don’t obscure vision are often acceptable, but a large, central bubble indicates improper insertion and requires removal and re-insertion. The lens should feel comfortable immediately. If there’s significant discomfort, irritation, or blurry vision, remove the lens and re-insert after inspecting it.
Repeat for the Second Eye: Follow the same steps for your other eye.

Troubleshooting Tip: If you repeatedly experience air bubbles, try leaning your head further forward, ensuring the lens is perfectly perpendicular to your eye during insertion, and maintaining the convex meniscus of saline. If the lens repeatedly falls off the plunger, ensure the plunger is clean and dry, and that the lens is properly seated.

The Ritual of Removal: Gentle and Effective Techniques

Removing scleral lenses requires a similar level of care and precision as insertion. Forceful or incorrect removal can damage the lens or, more importantly, your eye.

Preparation:

Wash Your Hands Thoroughly: Again, clean hands are paramount. Use mild, unperfumed soap, rinse thoroughly, and dry completely with a clean, lint-free towel.
Set Up Your Workspace: As with insertion, choose a clean, well-lit area, preferably over a flat, hard surface with a plugged drain if near a sink.
Prepare Your Lens Case: Open your dedicated scleral lens storage case and have your cleaning and disinfecting solutions ready.

The Removal Process:

Locate the Removal Plunger: Use the smaller, specialized removal plunger. This plunger typically has a narrower suction cup designed to adhere to the curved surface of the scleral lens.
Position Yourself: Stand or sit comfortably in front of a mirror.
Prepare Your Eye: Use the fingers of your non-dominant hand to firmly hold your upper eyelid. Use the fingers of your dominant hand to pull down your lower eyelid, creating a wide opening.
Position the Plunger: Gently place the suction cup of the removal plunger directly onto the surface of the scleral lens. Aim for the inferior (bottom) part of the lens, but slightly off-center if possible, to avoid direct contact with the cornea itself. You’ll feel a gentle suction as it adheres.
- Concrete Example: Imagine a small, soft vacuum cleaner nozzle gently attaching to a curved window pane.
Break the Suction and Remove: Once the plunger is securely attached, gently tilt the plunger downwards (towards your cheekbone) while simultaneously pulling slightly away from your eye. This motion helps to break the suction and allow the lens to detach smoothly. Do not pull straight out forcefully. The lens should “pop” off with a very subtle sensation.
Catch the Lens: As the lens detaches, quickly bring your other hand (if not holding the eyelid) or a cupped hand beneath your eye to catch the lens as it comes off the plunger. This prevents it from falling.
Place in Case/Proceed to Cleaning: Immediately place the removed lens into the appropriate well of your lens storage case or proceed directly to the cleaning step.
Repeat for the Second Eye: Follow the same steps for your other eye.

Troubleshooting Tip: If the lens doesn’t release easily, ensure you have a firm grip on your eyelids and that the plunger is centered and fully adhered. Do not tug or pull hard. Sometimes a very slight, gentle rocking motion of the plunger can help release the suction. If you struggle, consult your eye care professional for personalized tips or alternative removal methods.

The Cornerstone of Care: Daily Cleaning and Disinfection

This is the most critical aspect of scleral lens care. Skipping or rushing these steps significantly increases your risk of eye infection and compromises the performance of your lenses. Always follow the specific instructions provided by your eye care professional and the manufacturers of your solutions, as regimens can vary.

General Daily Cleaning and Disinfection Steps (Typical for Multipurpose or Peroxide Systems):

Wash Hands Thoroughly: (Yes, again!) Before handling your lenses, always wash your hands with mild, unperfumed soap and water, rinse thoroughly, and dry with a clean, lint-free towel.
Remove Lens and Place in Palm: Gently remove one scleral lens from your eye as described above. Place it in the palm of your clean, dry hand.
Apply Cleaning Solution: Apply several drops of your approved daily cleaning solution to the concave (inner) surface of the lens.
- Concrete Example: If using a hydrogen peroxide-based system, you might apply a specific cleaning solution before placing it in the neutralizing case. If using a multipurpose solution, this is your primary cleaning step.
Rub the Lens Gently: Using the pad of your ring finger (or another finger your eye care professional recommends, as the ring finger often applies the least pressure), gently rub the entire surface of the lens in a circular or back-and-forth motion for the time specified by the solution manufacturer (typically 10-20 seconds). Be thorough but avoid excessive force, which can damage the lens. Ensure you clean both the inner and outer surfaces.
- Concrete Example: Imagine polishing a delicate piece of glass, applying just enough pressure to remove smudges without scratching.
Rinse the Lens: Thoroughly rinse the lens with a steady stream of your approved rinsing solution (which might be the same as your disinfecting solution, or a separate saline rinse depending on the system). This removes loosened debris and cleaning solution residue.
Place in Disinfecting Case: Place the cleaned and rinsed lens into the appropriate well of your clean, dedicated lens storage case.
Fill with Fresh Disinfecting Solution: Completely fill the lens case wells with fresh, approved disinfecting solution. Ensure the lenses are fully submerged. Never “top off” old solution with new; always discard the old solution.
- Hydrogen Peroxide System Specifics: If using a hydrogen peroxide system, place the lens in the special neutralizing case (often containing a platinum disc). The solution will bubble, indicating the neutralization process. It’s crucial to allow the lenses to soak for the full recommended neutralization time (usually 6 hours or overnight) before inserting them into your eyes. Inserting lenses from a non-neutralized peroxide solution will cause extreme burning and damage to your eyes.
Soak for Recommended Time: Allow the lenses to soak for the minimum recommended disinfection time (typically 4-6 hours or overnight, depending on the solution type). This ensures all harmful microorganisms are killed.
Repeat for the Second Eye: Follow the same steps for your other eye.
Discard Used Solution and Air Dry Case: In the morning, after inserting your lenses, empty the lens case completely. Rinse it with fresh disinfecting solution (not tap water) and allow it to air dry, inverted, on a clean tissue or paper towel. Do not wipe it dry, as this can introduce lint or contaminants. Replace your lens case regularly, typically every 1-3 months, or as recommended by your eye care professional.

Beyond the Daily Grind: Weekly and As-Needed Care

While daily cleaning is the cornerstone, scleral lens care often extends to weekly routines and as-needed measures.

Weekly Protein Removal (if recommended)

Some eye care professionals may recommend a weekly protein removal step, especially if you experience persistent deposits or reduced comfort. This typically involves using an enzymatic cleaner.

Follow Manufacturer Instructions: Each enzymatic cleaner has specific instructions regarding mixing, soaking time, and rinsing. Adhere to these precisely.
Thorough Rinsing is Key: After enzymatic cleaning, rinse the lenses extremely thoroughly with your regular rinsing solution to ensure no enzymatic residue remains before placing them in your disinfecting solution. Residue can cause significant irritation.

Troubleshooting Minor Issues: When to Act

Sudden Discomfort or Redness: If you experience sudden, persistent discomfort, redness, blurred vision, excessive tearing, or light sensitivity while wearing your lenses, remove them immediately. Do not try to “tough it out.” Inspect the lens for damage or debris. Clean and disinfect thoroughly, then re-insert. If symptoms persist, do not re-insert the lens and contact your eye care professional immediately. This could be a sign of an infection or other serious complication.
Persistent Deposits: If you notice persistent haziness or a film on your lenses despite daily cleaning, consult your eye care professional. They may recommend a stronger cleaner, a different solution system, or professional in-office cleaning.
Damaged Lens: If your lens is chipped, cracked, or significantly scratched, discard it immediately. Do not attempt to wear a damaged lens, as it can cause serious eye injury.
Lost Lens: If you drop a lens and cannot locate it in a sterile environment, it’s best to consider it contaminated and discard it. Attempting to clean and reuse a lens that has fallen on an unsterile surface is a significant infection risk.

Travel and Emergency Preparedness: Staying Safe on the Go

Your scleral lens care routine shouldn’t stop when you travel. Planning ahead is crucial.

Travel-Sized Solutions: Purchase travel-sized versions of all your essential solutions (cleaning, disinfecting, preservative-free saline) or transfer them into approved travel bottles.
Extra Lens Case: Always pack an extra, clean lens case.
Backup Pair of Glasses: This is non-negotiable. If you lose a lens, damage one, or develop an eye irritation that prevents lens wear, you need a backup vision correction method.
Prescription Information: Carry a copy of your scleral lens prescription and your eye care professional’s contact information. This is vital in case of an emergency or if you need to purchase replacement supplies.
Never Use Tap Water: This bears repeating. Do not use tap water for rinsing, cleaning, or filling your lenses, especially when traveling to areas with questionable water quality. Tap water contains microorganisms that are harmless to drink but can cause severe eye infections.
Avoid Hotel Shampoo/Soap: Do not use hotel-provided soaps or shampoos for handwashing before lens handling, as they often contain perfumes and moisturizers that can irritate your eyes. Bring your own mild, unperfumed soap if necessary.

The Role of Your Eye Care Professional: Your Partner in Scleral Lens Success

Your eye care professional (ECP) is an indispensable resource in your scleral lens journey. They are not just the ones who fit your lenses; they are your ongoing partners in maintaining your eye health.

Regular Follow-Up Appointments: Attend all scheduled follow-up appointments. These visits are crucial for your ECP to monitor your eye health, assess the fit of your lenses, check for any deposits, and make adjustments as needed. They can detect potential problems before they become serious.
Reporting Issues Promptly: Do not hesitate to contact your ECP if you experience any persistent discomfort, redness, vision changes, or other concerns related to your lenses. Early intervention can prevent serious complications.
Solution Recommendations: Always follow your ECP’s recommendations for specific cleaning and disinfecting solutions. They choose these based on your individual eye chemistry, lens material, and lifestyle. Do not switch brands without their guidance.
Lens Replacement Schedule: Adhere to your ECP’s recommended lens replacement schedule. Even with meticulous cleaning, scleral lenses can accumulate microscopic deposits over time that aren’t visible to the naked eye but can compromise oxygen flow and comfort.

Common Pitfalls to Avoid: Learning from Others’ Mistakes

Even with the best intentions, mistakes can happen. Being aware of common pitfalls can help you avoid them.

Neglecting Handwashing: The single biggest mistake. Dirty hands are the fastest route to eye infections.
Using Tap Water: A critical error that can lead to severe infections like Acanthamoeba keratitis.
“Topping Off” Solution: Never add new solution to old solution in your lens case. Always discard the old, empty the case, and refill with fresh.
Not Rubbing the Lenses: Even with “no-rub” solutions, a gentle rub is often recommended and highly effective at dislodging debris and deposits. Check your solution’s instructions and your ECP’s advice.
Not Letting Cases Air Dry: A damp case is a breeding ground for bacteria. Air drying is essential.
Not Replacing Lens Cases Regularly: Old cases can harbor biofilms even after cleaning.
Over-Wearing Lenses: Adhere to your ECP’s recommended wearing schedule. Extended wear can lead to corneal stress and hypoxia.
Sleeping in Lenses (Unless Specifically Approved and Designed For): Scleral lenses are generally not approved for overnight wear. Sleeping in them drastically increases infection risk.
Using Expired Solutions: Expired solutions lose their efficacy and may no longer properly clean or disinfect your lenses.
Sharing Lenses or Solutions: Never, under any circumstances, share your lenses or solutions with anyone. This is a direct path to serious infection.
Using Saliva to Wet Lenses: Saliva contains a multitude of bacteria that are harmless in your mouth but can cause devastating eye infections.
Ignoring Symptoms: Any persistent eye discomfort, redness, or vision changes should prompt immediate lens removal and consultation with your ECP. Don’t self-diagnose or self-treat.

The Long-Term Benefits of Diligent Care: A Vision for the Future

The effort you invest in meticulous scleral lens care pays dividends far beyond simply avoiding infections. It contributes to:

Sustained Visual Acuity: Clean lenses provide consistently clear, stable vision, allowing you to fully appreciate the benefits of your custom correction.
Exceptional Comfort: A well-cared-for lens is a comfortable lens. Freedom from irritation and dryness enhances your quality of life.
Prolonged Lens Lifespan: Proper handling and cleaning protect your investment, ensuring your expensive lenses last for their intended duration.
Optimal Eye Health: Regular check-ups and diligent care safeguard the delicate structures of your eyes, preventing long-term complications and preserving your precious sight.
Confidence in Your Vision: Knowing you’ve taken every step to care for your lenses instills confidence, allowing you to live your life to the fullest without worrying about your vision.

Conclusion

Scleral lenses represent a remarkable advancement in ophthalmic care, offering unparalleled comfort and visual clarity for a wide range of corneal conditions. However, their success is intrinsically linked to the diligence and consistency of your care routine. This guide has provided a comprehensive framework, from the fundamental “why” to the precise “how-to” of insertion, removal, and daily maintenance. Embrace these practices not as burdensome chores, but as essential acts of self-care. By understanding the intricacies, acquiring the right tools, and committing to flawless execution, you empower yourself to unlock the full potential of your scleral lenses, ensuring years of healthy eyes, comfortable wear, and brilliant vision. Your commitment to meticulous scleral lens care is an investment in your long-term eye health and a clear, comfortable future.