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    Conjunctival prolapse and scleral lenses

    Conjunctival tissue drawn up under the lens near the limbus is a recognized scleral lens finding. Here is what the limited evidence says about its frequency, causes, and management.

    By the Scleral Lens Team · Updated October 2, 2026 · 5 published sources cited

    The short answer

    Conjunctival prolapse is limbal or perilimbal conjunctiva drawn into the space under a scleral lens. It is common: in an OCT study of 10 healthy adults, 8 showed it at least once during 90 minutes of wear, most often nasally, and its height tracked how far the lens settled at the limbus. Reviews describe it as usually benign but capable of causing discomfort or, if extensive, blocking vision. It is a fit issue to send back to the fitter, who may change the edge, landing zone, or limbal clearance.

    Key points

    • Observed in 37% of measurements and in 80% of 10 healthy participants at least once, in one OCT study.
    • More frequent nasally (73%) than temporally (27%) in that study.
    • Peak elevation correlated with limbal settling, not with landing zone compression or reservoir thickness.
    • Reviews list it among findings unique to scleral lens wear and describe it as generally benign.
    • The evidence base is one small experimental study plus reviews; there are no outcome data.

    What it is

    Conjunctival prolapse is conjunctival tissue near the limbus that rises into the space under a scleral lens, typically in the transition between the landing zone and the limbal vault. A 2016 review listed it, with epithelial bogging, midday fogging, and limbal bearing, among findings that appear unique to scleral lens wear.[2] A 2022 review of scleral lens assessment describes it as elevation of peripheral conjunctival tissue that may indicate peripheral misalignment, associated with compression and suction forces and the extent of limbal settling.[3]

    A 2025 review describes it as thickened, enlarged, or redundant limbal conjunctiva drawn into the limbal zone under the lens, attributes it to sectoral impingement where the lens edge is too steep, and notes it is seen more in older patients with looser conjunctiva but can occur at any age.[4]

    How common it is

    The only study designed to measure it used OCT in 10 healthy young adults (mean age 30) wearing a high-Dk sealed scleral lens for 90 minutes on three occasions, with low, medium, and high initial reservoir thickness.[1]

    • Prolapse was present in 37% of measurements across all conditions, and 8 of 10 participants (80%) showed it at least once.[1]
    • It was seen nasally more often than temporally (73% vs 27%).[1]
    • Peak height did not vary with reservoir thickness or location.[1]

    These are short sessions in normal eyes. The study tells you prolapse is common and easy to induce; it does not tell you how often it causes symptoms in established wearers or eyes with surface disease.

    What it is associated with

    In the OCT study, greater limbal settling correlated with higher peak prolapse (r = 0.48), while landing zone tissue compression and limbal reservoir asymmetry did not. With low reservoir thickness, eyes that developed prolapse started with more limbal clearance (97 vs 43 µm) and settled more over 90 minutes (85 vs 34 µm).[1]

    The 2025 review links it to a steep edge pinching the conjunctiva, and the 2022 review to compression and suction.[4][3] In the five-site fogging study, which assessed prolapse among other fit features, fit characteristics did not differ between eyes with and without fogging.[5]

    When it matters

    The 2025 review describes prolapse as generally benign. Symptoms tend to appear after lens removal and can lead to intolerance when the lens is reapplied. If a large amount of tissue is drawn under the lens, it can interfere with vision and may need intervention.[4]

    What to look for at your visit:

    • Lens on: elevated conjunctiva under the lens at the limbal transition, its quadrant, and whether it reaches toward the visual axis.
    • Lens off: conjunctival staining, hyperemia, or an elevated ridge in the same location, and any limbal staining.
    • Surface context: conjunctivochalasis, pinguecula, or inflamed conjunctiva in that quadrant.

    Management described in the reviews

    These are the options reviews describe; none has been compared in a trial.

    • Fit changes: flattening the lens edge, adjusting the base curve, or modifying the transition and landing zones. Reducing limbal clearance lessens the space that draws tissue in.[4]
    • Customized peripheries: back-surface toricity or customized peripheral designs can reduce localized compression and misalignment.[3]
    • Conjunctival treatment: anti-inflammatory therapy, including cyclosporine, lifitegrast, or short topical steroid courses, to help tighten redundant tissue, and surgical conjunctivoplasty for excessive conjunctivochalasis.[4]

    Lens changes belong to the fitter. Treating the conjunctiva, or referring for conjunctivoplasty, may fall to you. For the wider range of landing zone findings, see limbal and conjunctival findings in scleral wearers.

    Common questions

    Is conjunctival prolapse dangerous?

    Reviews describe it as generally benign. It can become a problem when it causes discomfort after removal, leads to intolerance on reapplication, or, if a large amount of tissue is drawn under the lens, interferes with vision. There are no long-term outcome studies.

    Should the patient stop wearing the lens?

    Not usually on your say-so alone. Send your findings to the fitter, who can judge whether the fit needs changing. Same-day removal is for pain, vision that doesn't clear with removal, or signs of infection.

    Is prolapse related to midday fogging?

    Not clearly. In a five-site study of 48 habitual wearers that recorded conjunctival prolapse among other fit characteristics, fit characteristics did not differ between eyes with and without fogging.

    Can anything other than a refit help?

    A 2025 review mentions anti-inflammatory treatment, such as cyclosporine, lifitegrast, or short topical steroid courses, to help tighten redundant conjunctival tissue, and surgical conjunctivoplasty for excessive conjunctivochalasis. These are the referring doctor's tools, and the review does not report outcome data for them in this setting.

    Keep reading

    Limbal and conjunctival findings in scleral lens wearers

    A scleral lens bears on the conjunctiva, so some landing zone change is expected: a faint impression ring after removal usually fades within hours. Sectoral or circumferential blanching during wear with rebound hyperemia after removal, edge impingement, quadrant staining, or limbal staining point to a fit problem that the fitter can usually correct with design changes. Imaging studies show measurable conjunctival vascular and thickness changes under the landing zone, of uncertain long-term significance. Limbal compromise in eyes with limbal stem cell deficiency needs closer attention.

    Scleral lens complications to watch for

    Most scleral lens problems are lens-related rather than physiological: broken lenses, deposits, poor wetting, and midday fogging. Physiological complications are less common and include conjunctival changes at the landing zone, corneal edema (higher risk in grafts), hydrops in keratoconus, and, rarely, microbial keratitis. Infection, rejection, and acute hydrops need same-day care; fit-related findings go back to the fitter.

    What the fitter sends back

    A complete report gives the final lens parameters and material, acuity in the lens, how the lens sits on the eye (central and limbal clearance, landing zone, any blanching or impingement), the corneal and conjunctival findings after wear, the care products and wear schedule, the follow-up plan, and anything the fitter needs you to act on. Expect an initial note after the evaluation and a final report once the fit is complete.

    Co-managing scleral lens patients

    The fitter manages the lens: fit, surface response, care regimen, and handling. You continue to manage the underlying disease and everything else in the eye. At your visits, examine the cornea and conjunctiva after lens removal, check acuity in the lens, and measure IOP with the lens out. Average IOP measured after removal has not changed in pooled studies, but pressure during wear is harder to measure and remains an open question for glaucoma and at-risk patients.

    Sources

    1. Fisher D, Collins MJ, Vincent SJ. Conjunctival prolapse during open eye scleral lens wear. Cont Lens Anterior Eye. 2021;44(1):115-119. doi:10.1016/j.clae.2020.09.001 pubmed.ncbi.nlm.nih.gov
    2. Walker MK, Bergmanson JP, Miller WL, Marsack JD, Johnson LA. Complications and fitting challenges associated with scleral contact lenses: a review. Cont Lens Anterior Eye. 2016;39(2):88-96. doi:10.1016/j.clae.2015.08.003 pubmed.ncbi.nlm.nih.gov
    3. Macedo-de-Araújo RJ, Fadel D, Barnett M. How can we best measure the performance of scleral lenses? Current insights. Clin Optom (Auckl). 2022;14:47-65. doi:10.2147/OPTO.S284632 pubmed.ncbi.nlm.nih.gov
    4. Rodriguez-Garcia A, Jimenez-Perez JC, Ruiz-Lozano RE, et al. Scleral lenses and PROSE: indications, complications, and future challenges. Med Hypothesis Discov Innov Ophthalmol. 2025;14(3):73-106. doi:10.51329/mehdiophthal1525 pubmed.ncbi.nlm.nih.gov
    5. Fogt JS, Schornack M, Nau C, Harthan JS, Nau A, Shorter E. Slit lamp findings in scleral lens wearers with and without subjective fogging. Eye Contact Lens. 2025;51(10):439-444. doi:10.1097/ICL.0000000000001204 pubmed.ncbi.nlm.nih.gov

    Last updated October 2, 2026. Found an error or a newer study? Let us know and we'll correct the page.