What each one is
A bandage contact lens (also called a therapeutic soft lens) is a soft contact lens placed on the eye to treat it, not to correct vision. It acts as a barrier between the eyelid and the cornea, which eases pain and protects the surface while it heals. Uses include painful corneal conditions, corneal abrasions and erosions, healing after surgery, and sealing very small corneal perforations.[1]
A scleral lens rests on the white of the eye and vaults over the cornea, with a reservoir of saline between the lens and the cornea. For a damaged surface, that means the cornea is kept wet and shielded from the eyelids. A review of therapeutic lenses notes that in severe ocular surface disease, such as severe dry eye and Stevens-Johnson syndrome, rigid scleral lenses are often used to help the cornea heal.[1]
The two situations where the choice comes up
Persistent epithelial defects. The epithelium is the cornea’s thin outer skin. A defect that hasn’t healed after about two weeks of standard treatment is called persistent. Standard treatments include lubrication, stopping drops that may be harming the surface, therapeutic contact lenses, and eyelid closure. Tougher cases may need serum eye drops, amniotic membrane, partial eyelid closure surgery, or medicines that target the underlying cause.[3] See our page on persistent epithelial defects.
Exposure. When the eyelids can’t close fully or blink properly, as after facial nerve palsy, the cornea dries out. A bandage soft lens is not a good choice here: the therapeutic lens review lists significant exposure keratopathy with inadequate eyelid position or movement as a reason not to use one.[1] A scleral lens’s saline reservoir is designed for exactly this problem. See our page on exposure keratopathy.
Side by side
| Bandage soft lens[1][2] | Scleral lens[5][8] | |
|---|---|---|
| What it is | A soft lens placed by the eye doctor as treatment | A custom rigid lens filled with saline |
| How it helps | Shields the cornea from the eyelid, eases pain | Keeps the cornea under fluid and shields it from the eyelid |
| Getting started | Placed at an eye clinic visit | Needs a specialist fitting |
| Wear pattern | As directed, for a set treatment period | Normally daily wear. Overnight wear only as a supervised treatment |
| Very dry or exposed eye | Not advised with significant exposure from poor eyelid closure | Designed to work in a dry or exposed eye |
| Vision | Doesn’t correct irregular corneas | Can improve vision on an irregular or damaged cornea |
| Main risks | Infection, low oxygen to the cornea, inflammation, poor fit | Infection, especially with overnight wear. Handling difficulty |
| Availability | Widely available | Limited to specialty fitters |
What the research shows
Bandage soft lenses
Safety under supervision. A German eye hospital reviewed 10 years of records for 638 patients prescribed a bandage lens. Serious events such as endophthalmitis (infection inside the eye) and emergency transplants did occur, but almost all were caused by the eye conditions the patients already had. Only two cases of endophthalmitis could be linked to the bandage lens. The authors concluded bandage lenses are safe given proper eye doctor supervision.[2]
Not the right tool for every wound. A systematic review comparing bandage lenses and amniotic membrane found bandage lenses useful for defects after surgery, while amniotic membrane was more effective for deep ulcers and nerve-related (neurotrophic) disease.[9]
Scleral lenses for defects that won’t heal
These studies involve people whose defects hadn’t healed with other treatments, including bandage lenses in many cases. They’re small case series from specialty centers.
- An early series. In a 2000 study of 14 eyes, scleral lenses worn continuously healed the defect in 8 eyes, some within days. But microbial keratitis (a corneal infection) developed in 4 of the 14 eyes, and the authors called it a significant risk.[4]
- With an antibiotic in the lens. The same center later added a preservative-free antibiotic to the saline and had patients wear the device overnight. Defects healed in 17 of 20 eyes, with a median of 8.5 days of overnight treatment, and there were no corneal infections.[5]
- A standardized protocol. Another center used round-the-clock wear with daily cleaning and an antibiotic in the reservoir. All 8 eyes healed with no infections, although 4 had recurrences that responded to restarting continuous wear.[6]
- Commercially available lenses. A case series of 8 eyes using three different scleral lens types reported complete healing in all, in an average of 11.1 days, without complications.[7]
Scleral lenses for exposure
In a study of people with exposure-related corneal disease who hadn’t improved with conventional treatment, 18 of 29 completed scleral lens fitting. Their vision improved from about 20/80 to about 20/35, and symptom scores and corneal staining improved.[8] See our exposure keratopathy page for more.
Questions to ask your eye doctor
- What’s causing my cornea not to heal, and does that change which lens would help?
- Is a bandage lens suitable, given how well my eyelids close?
- If a bandage lens doesn’t work, would you refer me for a scleral lens, amniotic membrane, or something else?
- If I’m treated with overnight scleral lens wear, how often will you see me and what drops will I use?
- What symptoms should make me call you the same day?
See also scleral lenses vs amniotic membrane and scleral lenses vs soft lenses for vision correction.
Common questions
Can I take a bandage lens out myself?
Ask first. A bandage lens is part of a treatment plan, and your eye doctor will tell you when and how it should come out. If it falls out, call the office.
Can I sleep in a bandage lens?
Only as your eye doctor directs. Wear instructions depend on why the lens was placed. Follow them exactly, use any drops they prescribe, and keep every follow-up appointment, because infection is one of the known risks of therapeutic lenses.
Can I sleep in my scleral lens to help my eye heal?
Not unless your eye doctor has specifically prescribed it. In studies, overnight scleral lens wear for non-healing defects was a supervised medical treatment, often with antibiotic drops added to the lens. It's different from normal scleral lens wear, where the lens comes out every night.
What happens if neither lens works?
There are other options for a defect that won't heal, including serum eye drops, amniotic membrane, temporarily closing the eyelids partway, and, for nerve-related damage, specific medications. Your eye doctor or corneal specialist will choose based on the cause.