What limbal stem cell deficiency is
The cornea (the clear front window of the eye) is covered by a thin surface layer that is constantly shed and replaced. The new cells come from stem cells at the limbus, the ring where the cornea meets the white of the eye.[1] Limbal stem cell deficiency (LSCD) is what happens when those stem cells, or the tissue that supports them, are damaged or destroyed.[2]
Without a healthy supply of new cells, the cornea can’t keep its surface intact. Tissue from the conjunctiva (the membrane over the white of the eye) creeps onto the cornea, which doctors call conjunctivalization. Blood vessels follow, and the cornea can scar and cloud.[2][7] Surface wounds may fail to heal.[1] Effects range from dryness and redness to corneal ulcers, failure of the eye surface, and loss of vision.[3]
Many things can cause it. Causes range from conditions present from birth, such as aniridia, to injuries such as chemical and thermal burns, to immune diseases such as Stevens-Johnson syndrome, to medical treatments. Contact lens wear is also a recognized cause, though the least understood.[2] Which causes are most common depends heavily on where you look. A 2025 review compared three large centers. At one in India, ocular burns were the leading cause, at 53.7% of cases. At one in Cincinnati, the most common cause was congenital aniridia, at 30.9%. At one in Minnesota, the leading cause was chemical and thermal burns, at 18.7%.[6]
Diagnosis and staging. In 2019 an international working group of cornea specialists agreed a shared definition of LSCD and a staging system based on what the doctor sees on examination.[4] Tests such as confocal microscopy (a microscope that images the cornea’s cells in the living eye) and impression cytology (gently sampling surface cells) can help confirm the diagnosis.[7]
LSCD can be partial or total, and in one eye or both. That shapes treatment. Surgery that uses the patient’s own stem cells is preferred when only one eye is affected, and donor tissue is used when both are.[7][5]
How a scleral lens helps
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 while the lens is in.
For an eye with LSCD, that can help in three ways:
- It can sharpen vision. The smooth front of the lens and the fluid layer beneath it mask an irregular corneal surface.
- It protects a fragile surface. The cornea stays wet, and the eyelids glide over the lens instead of rubbing unstable surface cells.
- It can support healing of surface wounds. In one study, the score for open wounds on the cornea improved during lens wear.[8]
One concern is specific to LSCD. The stem cells live at the limbus, and a scleral lens passes over the limbus on its way to resting on the white of the eye. Researchers have raised the concern that a lens pressing on the limbus, or limiting oxygen there, could harm cells that are already struggling. Their study is described below.[9] A careful fit that clears the limbus, and regular checks, matter more for LSCD than for most other conditions.
An international consensus of cornea specialists lists scleral lenses among the measures considered essential to prepare the eye surface before any LSCD surgery, alongside lid repair, controlling inflammation, treating dry eye, and cutting down on drops that are toxic to the surface.[5]
What the research shows
The evidence is a few retrospective case series, each from one center. They agree that vision often improves. They disagree on how the surface fares over time.
Vision improved for most eyes in one series. At one center, 31 eyes of 19 patients with LSCD were evaluated for PROSE (prosthetic replacement of the ocular surface ecosystem), a scleral lens treatment model, and followed for an average of about 25 months. Vision improved in 87.1% of eyes, and 71.0% gained two or more lines. Average vision improved from about 20/145 to about 20/58. The overall surface score didn’t change, but the score for open corneal wounds improved. At last follow-up, 77.4% of eyes were still wearing the lens, for an average of about 10 hours a day.[8]
A second series found a more mixed picture. At the Stein Eye Institute in Los Angeles, 27 eyes with LSCD confirmed by confocal microscopy were followed after being fitted with fluid-filled scleral lenses. Over time, vision improved in 25.9% of eyes, stayed stable in 48.1%, and decreased in 25.9%. The LSCD stage improved in 25.9%, stayed stable in 29.6%, and worsened in 44.4%. In five eyes with worsening disease, imaging showed the lens compressing the limbus and slower blood flow there. The authors suggested that low oxygen at the limbus may be the cause, and concluded that the lens fit needs close monitoring in these eyes.[9] These changes weren’t statistically significant, and the study had no comparison group, so it can’t show whether the lens caused the worsening.
Lenses are used after stem cell surgery too. In one study, 61 eyes with LSCD that had a simple limbal epithelial transplant (a stem cell graft) were then fitted with corneal or scleral rigid lenses for remaining scarring. Of those, 34 eyes wore scleral lenses. Median vision improved after surgery and improved further with the lenses, from about 20/200 to about 20/80. No complications were reported.[10]
Single cases show what’s possible. One case report described a patient whose LSCD was getting worse despite aggressive medical treatment. It settled quickly once scleral lens wear began, and the surface stayed intact for 18 months, even after lens wear stopped.[11] One case can’t tell you what will happen in your eye.
Other options, compared
Treatment depends on whether LSCD is partial or total, in one eye or both, and what caused it. Lenses and surgery are often used in sequence rather than as alternatives.[5][7]
| Option | What it does | Typically suited to |
|---|---|---|
| Optimizing the surface | Treats lids, inflammation, and dry eye, and reduces toxic drops | Every stage, and before any surgery |
| Scleral lens | Protects the surface and masks irregularity for clearer vision | Partial LSCD, or vision support before or after surgery; needs close monitoring |
| Removing invading conjunctival tissue | Scrapes away conjunctival cells so corneal cells can repopulate | Selected partial LSCD |
| Amniotic membrane | Tissue graft that supports healing of the surface | Partial LSCD and surface wounds |
| Stem cell transplant from the other eye | Moves healthy limbal tissue, directly or after growing it in a lab | One eye affected, with a healthy fellow eye |
| Donor stem cell transplant | Uses limbal tissue from a donor | Both eyes affected |
| Oral mucosal cell transplant | Uses cells from the lining of the mouth | Both eyes affected |
| Keratoprosthesis (artificial cornea) | Replaces the central cornea with a clear device | Both eyes affected with severe lid or surface problems |
Questions to ask a scleral lens fitter
- How many patients with limbal stem cell deficiency have you fitted?
- How will you make sure the lens clears my limbus and doesn’t press on it?
- How often will you check for signs that the deficiency is getting worse?
- Will you share your findings with my cornea specialist?
- Is a lens a long-term plan for me, or a bridge to stem cell surgery?
- If I have surgery, when could I go back to wearing a lens?
- What should I do if my eye becomes red or painful while I’m wearing it?
Common questions
Can a scleral lens cure limbal stem cell deficiency?
No. A lens can't replace lost stem cells. It can protect the surface, ease symptoms, and often improve vision. Restoring the stem cells, when that's possible, takes surgery such as a limbal stem cell transplant.
Can a scleral lens make my condition worse?
It's possible, which is why monitoring matters. In one study the deficiency worsened in 44% of eyes during scleral lens wear, and imaging in some of them suggested the lens was pressing on the limbus. The authors suggested low oxygen at the limbus as a cause. Ask your fitter how the lens is designed to clear the limbus, and expect regular checks.
Should I try a scleral lens before stem cell surgery?
Often, yes. An international consensus of cornea specialists lists a scleral lens among the steps considered essential to get the eye surface as healthy as possible before surgery. Your cornea specialist will decide the order of treatment for your eye.
Can I wear a scleral lens after a limbal stem cell transplant?
Many people do, once their surgeon says the eye is ready. In a study of 61 eyes fitted with rigid lenses after a type of stem cell transplant, vision improved further with the lenses and no complications were reported. Your surgeon and fitter will decide the timing together.
Can contact lenses cause limbal stem cell deficiency?
Contact lens wear is one recognized cause, though it is the least understood. That is one reason a fitter will want to check the limbus closely at every visit, whatever kind of lens you wear.
Is swelling, redness, or irritation while wearing the lens normal with LSCD?
Don't assume it is. A lens that sits too tight or presses near the limbus can cause redness and irritation, and with LSCD that matters more than usual. Tell your fitter promptly, since design changes such as more clearance or channels may help. If the eye is painful, very red, or your vision drops, remove the lens and call your eye doctor today.
Can serum tears be added to the lens fill?
Some wearers with LSCD say serum tears in the fill made the lens more comfortable, but only on their doctor's direction. Adding anything to the fill besides the prescribed saline is off-label. Ask your cornea specialist and fitter whether it suits your eye.
My lens fogs up very quickly. What can be done?
A damaged corneal surface can shed debris into the saline under the lens, which clouds vision. Changes to the fit, the fill, or treatment of surface inflammation sometimes reduce it. If nothing has helped, a second opinion from a fitter experienced with LSCD is reasonable.
Does the type of scleral lens matter for LSCD?
The design matters more than the brand. Lenses shaped closely to your eye, for example from a scan or a mold of the eye surface, can help spread pressure evenly and keep clear of the limbus, and some wearers have done better after switching designs. No single lens suits everyone, so ask your fitter how they will keep the lens off the limbus.