What each one is
Autologous serum eye drops (“autologous” means from yourself) are made from a sample of your own blood. Serum is the liquid left after blood clots. The idea is that serum contains more of the components of natural tears than artificial tears do, so it may lubricate and also support the eye’s surface.[1] They’ve been used for decades for dry eye, persistent epithelial defects (spots on the cornea that won’t heal) and neurotrophic keratopathy.[4] The 2025 international TFOS DEWS III report lists serum among “biologic tear substitutes” for dry eye driven by particular underlying causes.[6]
A scleral lens is a large rigid contact lens that rests on the white of the eye and vaults over the cornea. Before it goes in, it’s filled with preservative-free saline, so while you wear it the cornea sits under a reservoir of fluid, protected from the air and from the rubbing of the eyelids.
Side by side
| Autologous serum drops[4][1] | Scleral lens[8] | |
|---|---|---|
| What it is | Eye drops made from your own blood | A custom rigid lens filled with saline |
| How it helps | Adds tear-like components to the eye’s surface | Keeps the cornea covered in fluid and shielded from the lids |
| Vision | Doesn’t correct vision directly | Can improve vision, especially if the surface is irregular |
| Getting started | Blood draw, then preparation in a lab, eye bank or blood bank | Custom fitting, usually over several visits |
| Daily routine | Drops several times a day, as prescribed | Insertion, removal, cleaning, and filling with saline |
| Storage | Kept cold. Spare bottles usually frozen | Lens kept in a case with disinfecting solution |
| Main risks | Contamination of the bottle, as serum has no preservative | Handling difficulty, fogging, infection risk shared with all contact lenses |
| Evidence | Small trials, mixed results | Mostly case series, consistent benefit in those studies |
What the research on serum drops shows
The trials are small and the results are mixed.
- A 2017 Cochrane review found five randomized trials with 92 participants in total. It rated the evidence low or very low certainty. Serum might help symptoms a little more than artificial tears in the short term, but there was no evidence of an effect after two weeks.[1]
- A 2023 review using the same strict methods included six trials with 116 participants and concluded the effectiveness of serum “is uncertain based on current data”.[2]
- A 2024 meta-analysis cast a wider net, pooling 12 randomized trials, and found that serum improved tear production, tear film stability, corneal staining and symptom scores compared with artificial tears.[3]
Why the difference? The reviews included different trials and used different standards for which data could be combined. Reviewers also note there’s no agreed recipe: the strength of the drops, what they’re diluted with, and how blood is processed and stored all vary.[5] One review describes 20% serum as widely used for moderate dry eye, with stronger concentrations possibly working better in severe cases.[5]
What using serum drops involves
Practice guidelines describe the drops being prepared in a blood bank, eye bank or lab with sterile work areas. Bottles are sent home cold, with the bottle in use kept in the fridge and the rest in the freezer. Because serum is unpreserved and is a good medium for germs to grow, the guidelines recommend using each opened bottle within two to three weeks and handling it carefully.[4]
What the research on scleral lenses shows
The evidence is mostly from case series at specialty clinics, without comparison groups.
- Moderate to severe dry eye. In a study of 41 eyes of 25 people, many with Stevens-Johnson syndrome or Sjögren’s syndrome, a year of scleral lens wear improved vision, tear test results, dry eye symptoms and quality of life.[7]
- People who had tried other treatments. At a US tertiary center, 212 people with ocular surface disease were evaluated for scleral lenses. They had already tried an average of 3.2 other treatments. Of the 115 who completed fitting, all but 2 reached their treatment goals, and average vision improved from about 20/42 to about 20/26.[8]
- Long-term wear. In a five-year follow-up of 121 people using one type of scleral device, 73.6% were still wearing it. Continued wear was lower in people treated for ocular surface disease (64%) than for an irregular cornea (84%).[9]
- Quality of life. In a study of 49 people with severe ocular surface disease, 92% reported a better quality of life, mostly through less light sensitivity and discomfort, and average wear was 13.7 hours a day.[10]
Using them together
These aren’t either/or. Serum works on the surface chemistry. A scleral lens works by protecting and hydrating. In the 49-person study, many patients had other procedures before or after lens fitting, such as punctal occlusion.[10] No study we found has tested whether combining serum and scleral lenses works better than either alone. If you’re on serum drops and considering a scleral lens, ask both your eye doctor and your fitter how they’d fit together in your routine.
Questions to ask your eye doctor
- What’s driving my dry eye: low tear production, inflammation, a problem with the oil glands, or something else?
- Would serum drops or a scleral lens address that cause better?
- How would I get serum drops made, and how long would that take?
- Could I use both? How would the timing work?
- What will we measure to tell whether either one is working?
See also our pages on severe dry eye, Sjögren’s syndrome, and scleral lenses vs punctal plugs.
Common questions
How are serum eye drops made?
Blood is drawn from your arm and allowed to clot. It's spun in a centrifuge to separate the serum, which is then usually diluted, filtered, and divided into small sterile dropper bottles under clean conditions. Methods vary between labs and countries.
How do I store serum drops?
Follow the instructions you're given, because they vary. One set of practice guidelines describes keeping the bottle in use in the fridge, keeping spare bottles frozen, and thawing a new one as needed. Serum has no preservative and can grow germs, so clean handling matters.
Can I use serum drops with scleral lenses?
Ask your eye doctor and fitter. The two work differently, so there's no built-in conflict, but they'll tell you when to use drops relative to wearing the lens and whether anything should go in the lens reservoir. Don't add anything to the saline in your lens unless your doctor tells you to.
Which works faster?
There's no study comparing the two directly. A scleral lens covers the cornea from the moment it goes in, but fitting takes several visits. Serum drops need a blood draw and preparation before you can start.