Can you sleep in scleral lenses?

The short version: lenses out before any sleep

Scleral lenses are daily wear lenses. They go in after you wake up and come out before you sleep, and that includes naps on the couch, on a plane, or as a passenger on a long drive. The FDA lists sleeping in daily wear lenses among the things not to do, because it may increase your chance of infection or irritation.^[1]

Why sleeping in lenses is risky

Infection risk goes up. A CDC report on corneal infections linked to sleeping in contact lenses notes that sleeping in lenses, whether by accident, now and then, or as a planned schedule, raises the risk of eye infection six- to eightfold.^[3] The six patients it describes needed frequent antibiotic drops and many follow-up visits, and some were left with permanent eye damage.^[3] Those patients wore various kinds of contact lenses, not specifically scleral lenses, but the lesson applies to any lens.

A large Australian study of contact lens infections reached the same conclusion: overnight use of any contact lens carried a higher risk than daily use.^[4]

Your cornea gets less oxygen. A scleral lens covers the whole cornea, and because it’s large, little fresh tear fluid moves under it. A report of Acanthamoeba infections in scleral lens wearers listed that reduced oxygen among the possible risk factors.^[5]

Closing your eyes reduces it further. Pooled data from 22 studies of daytime, eyes-open scleral lens wear found only a small average amount of corneal swelling, under 1%.^[6] In a separate small lab study, 10 people with healthy corneas wore scleral lenses with their eyes closed for just 90 minutes, and their corneas swelled by roughly 4 to 5% on average.^[7] The two studies used different methods, so the numbers aren’t a precise comparison, but the direction is clear: closed eyes over a scleral lens are harder on the cornea, even over a nap-length stretch.

The medical exception

You may read that some patients wear scleral devices overnight. That happens, rarely, as a treatment, not a convenience. For example, a specialist center reported treating 20 eyes with persistent corneal wounds that wouldn’t heal, using overnight wear of a scleral device with a preservative-free antibiotic added to the fluid; 17 of the 20 eyes healed.^[8] The center reported fewer infections than in its earlier series of this treatment, which it linked to adding the antibiotic.^[8]

That is a prescribed treatment for a specific condition, chosen by the doctor. It isn’t a sign that overnight wear is safe for everyday use. If you have a condition like a persistent epithelial defect, your specialist will tell you if it applies to you.

If you fall asleep in your lenses

It happens. Here’s what to do:

1. Take the lenses out as soon as you wake up. Use artificial tears first if the lens feels tight, then your removal plunger. See how to remove a scleral lens.
2. Wear your glasses for the rest of the day if you can, to give your eye a rest.
3. Watch your eye. Redness, pain, blur, light sensitivity, or discharge can be signs of a problem. The FDA advises removing lenses and contacting your eye care professional right away if you have symptoms of irritation or infection, and keeping the lenses in their case so your doctor can check them.^[2]
4. Tell your fitter, even if you feel fine.

Making it easier to remember

Most accidental sleep happens when you’re tired, traveling, or ill. A few habits help: take your lenses out as soon as you get home on long days, fly in your glasses, and keep a case, solution, and remover in your bag so you can take the lenses out wherever you are. Our wearing schedule guide and travel guide cover the details.