What a pinguecula is
A pinguecula is a common, benign change in the conjunctiva, the thin membrane over the white of the eye. It looks like a grey, white or yellowish raised spot on the white of the eye, and is often in both eyes. It’s linked to exposure to wind, dust, ultraviolet light and long hours outdoors.[1]
On its own it often causes no more than a cosmetic concern. Mild symptoms such as a foreign-body feeling or itching are usually treated with artificial tears, and surgical removal is rarely considered, mainly for cosmetic reasons.[1]
Why it matters for a scleral lens
A scleral lens rests on the conjunctiva over the white of the eye, so a pinguecula can sit right where the lens lands. If the edge lands on the bump, wearers describe:
- Rubbing or a sore spot, often near the inner corner, sometimes only after a few hours of wear.
- Redness around the bump, or a bloodshot corner after wear.
- A lens that won’t settle, moves, or lets debris in, because it’s resting unevenly.
- Inflammation of the pinguecula itself, called pingueculitis.
A review of scleral lens complications lists irritation from a pinguecula among the problems related to fitting, and notes such problems are reported infrequently.[2] In a retrospective study of 157 keratoconus eyes fitted with scleral lenses for at least a year, pingueculitis occurred in 1.3% of eyes.[3]
How fitters work around it
For pressure caused by a specific feature on the eye, the review describes options including raising the lens edge in that area, making the lens smaller, or notching it, and quadrant-specific designs when one area needs different treatment from the rest.[2] Wearers describe the same options:
- A notch: a cut-out in the edge where the pinguecula sits.
- A vault or microvault: a small raised area, or channel, that lifts the lens over the bump.
- A quadrant-specific or toric edge that lands differently in different directions. See toric landing zones.
- A different size, so the edge lands before or beyond the bump. Some wearers whose mini-scleral lenses rubbed did better with a larger lens.
- Impression-based or scan-based designs that map the bump and follow it. See impression-based lenses and scleral profilometry.
A notched or vaulted lens has to stay in the same orientation, so it usually includes features to stop it rotating, and you may need to insert it a particular way up. Ask your fitter how to tell.
Removal first, or not?
Usually not. Wearers report being told by more than one doctor that surgery could leave scar tissue that’s harder to fit around than the pinguecula, and that changing the lens is the better first step. If your eye doctor recommends removal for another reason, ask your fitter about timing, as for any surgery on the surface of the eye. See scleral lenses after pterygium surgery, a related growth.
What wearers say
Many wearers with pingueculae wear scleral lenses comfortably once the lens is shaped to clear them. It often takes more lenses and visits than a simple fit. Several say a notch or vault made the difference between irritation and comfort, and a few had to push for further adjustments when a notch was too small. Wearers also advise building up wear time gradually with a new design and watching for redness at the spot.
What to ask your fitter
- Is my pinguecula under the lens edge, and is it being pressed?
- Would a notch, a vault, a quadrant-specific edge or a size change suit my eye?
- How do I make sure the lens goes in the right way up?
- How many adjustments are included in my fitting period?
Common questions
Should I have my pinguecula removed before a fitting?
Ask your eye doctor, but it's usually not the first step. A pinguecula is benign, and surgery for it is rarely considered. Wearers report doctors advising that removal could leave scar tissue that's harder to fit around than the pinguecula itself, and preferring to change the lens.
What's a notch or a microvault?
Both are ways of shaping the lens around a raised spot. A notch is a cut-out in the edge at that position. A vault or microvault raises a small area of the lens so it clears the bump. The lens then needs to stay in the same orientation, so your fitter may add features that stop it rotating.
My notch is too small and still rubs. What can I do?
Tell your fitter, with details of where and when it rubs, and ask what's included in your fitting period. Wearers advise not accepting a lens that rubs as the final fit. If it's past the fitting window, ask what a remake would involve.
Can a scleral lens make my pinguecula grow?
We didn't find evidence that it does. Wind, dust and sunlight are linked to pingueculae, which is one reason wearers use wraparound sunglasses. If the pinguecula seems to be changing, have your eye doctor look at it.