Can you use eye drops with scleral lenses?

Two different places a drop can go

With a scleral lens, there are two places fluid can end up, and they have different rules.

• On top of the lens: drops you put in your eye while the lens is in. They wet the front of the lens and the eye’s surface around it.
• In the bowl: the fluid you fill the lens with before you insert it. It sits against your cornea, trapped under the lens, for hours.

Because the fluid in the bowl stays against your cornea for so long, it needs to be the gentlest thing possible.

In the bowl: saline only, unless your doctor says otherwise

Fill your lenses with sterile, preservative-free saline. A review of scleral lenses for eye surface disease explains that patients are told to fill with preservative-free saline to avoid toxicity to the eye’s surface from preservatives.^[1] Single-use vials are the most common choice: in an international survey of fitters, 67% of patients used single-use vials of non-preserved saline.^[4] A report on Acanthamoeba infections in scleral lens wearers recommends sterile saline, preferably single-use.^[5]

There are exceptions, and they’re made by doctors, not wearers. For some severe eye surface conditions, specialists add specific preservative-free medicines to the fluid in the bowl, such as an antibiotic during treatment of a wound that won’t heal.^[6] Don’t put anything other than saline in your lens unless your doctor has told you exactly what, how much, and for how long.

The products that go with your lenses are covered in saline and solutions.

On top of the lens: preservative-free artificial tears

The same review notes that people with eye surface disease can use preservative-free artificial tears directly over the lens as needed through the day.^[1] Many wearers use them to keep the front of the lens comfortable, or a drop or two before removal to help loosen the lens. See how to remove a scleral lens.

Ask your fitter which brand they want you to use. Not all drops are the same, and some aren’t meant for use with contact lenses.

Why preservatives matter

Many multi-dose eye drops contain preservatives to keep the bottle sterile. The most common, benzalkonium chloride (BAK), is used in about 70% of eye drug formulations and is well known to damage cells on the cornea and conjunctiva.^[2] A review of the evidence found these effects are worse with long-term use, as with lifelong glaucoma treatment, but can appear after as little as seven days.^[2] For people with eye surface disease, the scleral lens review advises removing BAK-preserved tears and medicines where possible, especially glaucoma drops, since alternatives often exist.^[1]

Prescription drops: timing matters

If you use prescription eye drops for another condition, such as glaucoma, allergy, or inflammation, don’t assume they can go over your lens. The scleral lens review advises using prescription drops before or after lens wear and waiting at least 10 minutes after the drops before putting your lenses in.^[1] Your own doctor may give you different instructions, and theirs come first.

The FDA’s general advice for contact lens wearers is to ask your eye care professional before using any medicine or eye product, even ones you buy without a prescription.^[3]

What to ask

• “Which artificial tears can I use over my lenses?”
• “Can my prescription drops be switched to preservative-free versions?”
• “When should I use my drops relative to putting my lenses in and taking them out?”
• “Should my glaucoma doctor and my fitter talk to each other?”