How chemical injuries affect the eye
Chemical eye injuries are common and can be serious. A national study of US emergency departments counted 144,149 chemical eye burns from 2010 through 2013. Young children had the highest rates, and among injuries identified as acid or alkali, alkali burns were slightly more common.[3] Chemical burns account for 11.5% to 22.1% of eye injuries.[1] Injuries at home tend to be milder. Workplace injuries are more often severe and affect both eyes.[2]
Alkalis and acids behave differently. Alkalis break down tissue and penetrate deep into the eye. Acids tend to cause rapid coagulation of the surface tissue, which can limit how far they penetrate. Irritants such as alcohol mainly strip the surface layer.[2] Severity depends on the chemical, how long it stayed in contact, and how quickly treatment began.[2]
The lasting damage often comes from the limbus. The limbus is the ring where the cornea meets the white of the eye, and it holds the stem cells that renew the cornea’s surface. A severe burn can starve or destroy that region. When the stem cells are lost, the surface can’t heal properly. Wounds stay open, conjunctival tissue grows over the cornea, blood vessels follow, and the cornea scars. Damage to the glands and cells that make tears adds severe dryness.[4] This is called limbal stem cell deficiency.
Other long-term problems after a severe burn include scar bands between the eyelid and eyeball, glaucoma, cataract, and eyelid damage that leaves the eye exposed.[4] Recovery is often a long process with several stages of treatment. Specialists recommend referral to a tertiary center for people with stem cell failure or scarring that limits vision.[5]
Where a scleral lens fits in recovery
A scleral lens is a large rigid gas-permeable lens. It rests on the sclera (the white of the eye) and arches over the whole cornea without touching it. Before insertion it is filled with sterile, preservative-free saline, so a layer of fluid covers the cornea for as long as the lens is in.
After a chemical injury, a lens is usually considered once the acute phase is over. It can help in a few situations:
- Before stem cell surgery. An international consensus of cornea specialists lists scleral lenses among the measures considered essential to get the eye surface as healthy as possible before surgery for limbal stem cell deficiency.[6]
- After stem cell surgery. A successful stem cell graft can still leave scarring and an irregular surface. A rigid or scleral lens can sharpen vision further.[7]
- When the eyelids were damaged. If burns left the lids unable to close, the saline reservoir keeps the cornea covered and wet while the lens is in.[9][10]
- For comfort and protection. The fluid layer protects a dry, fragile surface from the air and the eyelids.
Whatever the role, the lens works alongside your cornea specialist’s plan. It doesn’t replace stem cell surgery, eyelid repair, glaucoma treatment, or other care your eye needs.
What the research shows
The evidence is limited. There are no trials comparing scleral lenses with other approaches after chemical injury. Most of what is published is case reports, plus a few series in which chemical injury is one of several causes. Read the results as a sign of what is possible, not a prediction.
After stem cell surgery, lenses improved vision further. In a study from India of 61 eyes with limbal stem cell deficiency that had a simple limbal epithelial transplant (a stem cell graft), chemical injury was the cause in 77%. After surgery, the eyes were fitted with corneal rigid lenses (27 eyes) or scleral lenses (34 eyes). The median gap between surgery and lens trial was 10 months. Median vision improved from about 20/200 after surgery to about 20/80 with lenses. In eyes with chemical injury, the improvement with lenses was statistically significant. No complications were reported during follow-up.[7]
Children can be fitted too. A 2026 study from a center in South India reviewed 91 eyes of 67 children with ocular surface disease fitted with scleral lenses over 17 years. Fourteen eyes had chemical injury, and 10 of those had a stem cell graft before fitting. Across the whole group, vision improved, blood vessels growing into the cornea decreased in 73% of eyes, and no lens-related infections occurred. The lens edge pressed into the conjunctiva in 12% of eyes.[8] Results weren’t reported separately for the children with chemical injury.
Lenses have protected eyes after severe burns that destroyed the eyelids. One case report described a patient with a severe chemical burn and complete loss of the eyelids whose exposed cornea was protected with a custom scleral lens, with good vision and comfort.[9] A second case report described a man with a severe acid burn covering 45% of his body, loss of his eyelids, and surgery on both eyes. Large scleral lenses improved his vision and helped stabilize the eye surfaces.[10] These are single cases and say nothing about how often this works.
Other options, compared
Care after a chemical injury is usually staged. A scleral lens is one tool among several, and most people need more than one.[1][6]
| Option | What it does | Typically suited to |
|---|---|---|
| Immediate rinsing and emergency care | Removes the chemical and limits damage | Every chemical injury, straight away |
| Medicines to control inflammation and support healing | Calm inflammation and help the surface heal | The early weeks after injury |
| Amniotic membrane | Tissue graft placed on the eye to support healing | Moderate to severe acute burns |
| Scleral lens | Protects the surface and masks irregularity for clearer vision | After the acute phase, before or after surgery |
| Stem cell transplant | Restores limbal stem cells from the other eye, a donor, or other tissue | Limbal stem cell deficiency after a burn |
| Eyelid and surface reconstruction | Repairs lids and releases scar bands | Eyelid damage, scar bands |
| Corneal transplant or artificial cornea | Replaces scarred cornea | Scarring once the surface is stable, or end-stage disease |
Questions to ask a scleral lens fitter
- How many patients have you fitted after a chemical eye injury?
- Will you work with my cornea specialist, and is my eye ready for a lens?
- Is the lens a bridge to stem cell surgery, or something I’ll wear after it?
- Does scarring on my eye change how you’ll fit the lens?
- How often will you check for infection, pressure on the conjunctiva, or changes at the limbus?
- If my eyelids were damaged, how should I protect my eye when the lens is out?
- What should I do if my eye becomes red or painful while I’m wearing it?
Common questions
I just got a chemical in my eye. What should I do?
Rinse the eye immediately with plenty of water and keep rinsing, then get emergency care. Don't wait to read further. Scleral lenses play no part in emergency treatment.
How long after a chemical injury can I be fitted for a scleral lens?
There is no fixed timeline in the research, and it depends on how badly the eye was hurt and what surgery it needs. In one study of lenses fitted after stem cell surgery, the median gap between surgery and the lens trial was 10 months. Your cornea specialist decides when the eye is ready.
Will a scleral lens restore my vision completely?
Usually not completely, and it depends on the damage. A lens can sharpen vision by smoothing an irregular surface, but it can't clear deep scarring or replace lost stem cells. In one study, median vision with lenses after stem cell surgery was about 20/80.
Can I wear a scleral lens if my eyelids were burned too?
Sometimes. Case reports describe large scleral lenses protecting the eye in people who lost much of their eyelids in severe burns. These are complex situations managed by specialist teams, and they still need a plan for protecting the eye when the lens is out.
Is there a risk of infection?
Yes, as with any lens on a damaged eye. Two studies of lenses after chemical injury reported no infections, but they were small. Follow your cleaning routine exactly, and if your eye becomes red, painful, or more blurry, take the lens out and call your eye doctor the same day.