Scleral lens habits to avoid: what wearers do that they shouldn't

Nobody sets out to take risks with their eyes. Shortcuts usually start with a good reason: saline is expensive, the peroxide won’t fit in a carry-on, the lens is uncomfortable and the appointment is weeks away. Wearers who have been at this a long time say the same thing again and again: the habits below are where infections and injuries tend to start.

1. Letting water touch your lenses

The habit. Showering or swimming with lenses in, sometimes under goggles. Sitting in a hot tub or steam room. Rinsing a lens, case or plunger under the tap. Shrugging off a splash or a raindrop.

Why it’s risky. The FDA advises keeping contact lenses away from any water, whether tap, bottled, distilled, lake or ocean, and taking lenses out before swimming because of infection risk from pools, hot tubs, lakes and the ocean.^[1] Tap and distilled water have been linked to Acanthamoeba keratitis, a corneal infection the FDA describes as resistant to treatment and cure.^[1] A scleral lens holds a pool of fluid against your cornea all day, and wearers point out that water trapped there has nowhere to go. Some wearers were taught to rinse with tap water years ago, or even by clinic staff. It still isn’t safe.

Instead. Take lenses out before you shower, swim or wash your face. Rinse with sterile saline only. Keep plungers dry too: they touch the lens. See swimming and showers and inserters and removers.

2. Sleeping or napping in your lenses

The habit. Dozing on the couch, napping on a plane, or wearing lenses straight through a long shift or travel day.

Why it’s risky. The FDA lists sleeping in daily wear lenses among the things not to do, because it may increase your chance of infection or irritation.^[4] Many wearers describe waking with a red, burning or blurry eye after accidental sleep, and some needed time out of lenses to recover.

Instead. Lenses out before any sleep, and carry a case, solution and remover so you can take them out anywhere. If it happens, see can you sleep in scleral lenses for what to do next.

3. Putting the wrong liquid in the bowl

The habit. Filling with a multipurpose or conditioning solution, or putting the lens in without rinsing it off. Filling with a preserved or “sensitive eyes” saline. Rinsing or filling with peroxide that hasn’t been neutralized. Using nasal saline, homemade saline, or homemade drops such as honey mixtures.

Why it’s risky. Whatever you put in the bowl sits against your cornea for hours. Wearers report burning and redness from preserved products in the bowl, and intense stinging when a lens was filled with peroxide or cleaner by mistake. The FDA warns that unneutralized hydrogen peroxide in the eye may cause stinging, burning, irritation or eye damage,^[3] and says never to use non-sterile water or any homemade saline solution.^[1] Nasal saline is not made for eyes.

Instead. Fill with sterile, preservative-free saline made for scleral lenses, rinse off any storage solution with it first, and use products your eye care professional recommends.^[2] Red caps on most peroxide bottles are a reminder that they need special care.^[3] See filling solutions and multipurpose and GP solutions.

Off-label fills, such as inhalation saline (Addipak or McKesson) or a thicker drop like Celluvisc in the bowl, aren’t on this list. They’re a decision to make with your fitter, and the filling solutions page explains them.

4. Reusing, stretching or topping off

The habit. Recapping a single-use vial for later or the next day. Keeping an opened bottle past its discard date. Topping off yesterday’s solution in the case, or storing lenses in saline. Using expired products or keeping a case until it breaks. Pouring solution into a small travel bottle.

Why it’s risky. Once a vial is open it is no longer sterile, and wearers have described infections and ulcers after reusing opened saline. The FDA says not to top off solutions in your case, to discard leftover solution after each use, never to reuse lens solution, and not to use solutions past their expiration or discard date.^[2] It also advises against transferring solutions into smaller travel containers, which can affect sterility,^[2] and recommends replacing your case every three months or as your eye care professional directs.^[1] Saline rinses but does not disinfect.^[2]

Instead. Open a fresh vial each time you fill. Store lenses only in fresh disinfecting solution. See storing scleral lenses and lens cases. If cost is the reason, saving money on supplies has safer ideas.

5. Peroxide shortcuts

The habit. Using plain drugstore hydrogen peroxide with a lens-care disc. Diluting a stronger peroxide at home. Keeping the same disc after the bottle it came with is finished. Taking lenses out before the soak is done, or rinsing them early in an emergency. Leaving the basket lid loose because a large lens won’t fit.

Why it’s risky. The FDA says peroxide must be neutralized to avoid eye damage, that you should always use the case that comes with each new bottle because an old case will not neutralize the peroxide, and that lenses must soak for the full time on the label before they go in your eye.^[3] It also advises not changing your lens-care system before talking to an eye care professional.^[3] A lens that isn’t fully covered by solution, or a basket that doesn’t close, may not be disinfected.

Instead. Use a lens-care peroxide system as labeled. If your lens doesn’t fit the case, ask your fitter about a case or system that does. If you’re mid-soak and need your lenses, wear your glasses. See hydrogen peroxide.

6. Treating your own eye

The habit. Reaching for leftover antibiotic or steroid drops when an eye turns red. Asking a pharmacy abroad for something for a sore eye. Using numbing drops at home to make insertion easier. Masking redness with whitening drops.

Why it’s risky. The FDA says you cannot judge how serious a problem is while wearing contact lenses and need an eye care professional to determine it.^[1] It also advises asking your eye care professional before using any medicine or eye product, even ones sold without a prescription.^[4] Numbing drops are something eye doctors use in the office; wearers warn against using them at home.

Instead. Call your eye doctor. See steroid and antibiotic drops with scleral lenses and eye drops with sclerals.

7. Pushing through warning signs

The habit. Wearing a lens that hurts, leaves deep marks or causes redness every day while waiting for a remake. Wearing a cracked or chipped lens. Keeping lenses in through a painful, watery eye. Waiting days to call about new symptoms.

Why it’s risky. Eye infections and corneal ulcers can develop very quickly, and the FDA advises removing your lenses immediately, not putting them back in, and contacting your eye care professional if you have symptoms of irritation or infection.^[1] A crack or chip weakens a lens, and wearers describe lenses breaking during removal.

Instead. Wear your glasses and call. Read is my lens too tight?, cracked lens and eye pain: when to get help.

8. Handling shortcuts

Redrawing orientation dots yourself. We don’t recommend it. Fitters regularly see patients who redrew their dots and turned out to be wearing their lenses in the wrong eyes. Ask your fitter or the lab instead. See faded dots and right and left lenses mixed up.

Wiping or cleaning the lens while it’s in your eye. We don’t recommend it, with a swab or anything else. Take the lens out, clean it, and refill. See film and deposits on the lens.

Cleaning lenses with dish soap or hand soap. Soap isn’t a lens-care product and can leave residue. The FDA advises cleaning and disinfecting lenses following the labeling of your lens-care products.^[1] See cleaning and disinfecting and which hand soap to use.

9. Buying unverified products

The habit. Buying an unfamiliar saline from an online marketplace during a shortage, choosing a bargain from a third-party seller, or finishing a box from a recalled lot.

Why it’s risky. Wearers have reported knockoff and unregistered salines sold online, leaking packaging, and expired stock. A non-sterile saline sits against your eye all day.

Instead. Buy from the maker, your fitter’s office, a pharmacy or a retailer you trust, check lot numbers during recalls, and use products your eye care professional recommends.^[2] See shortages, recalls and counterfeit saline and ran out of saline abroad.

What to ask your fitter

• “Which products are approved for my lenses, and what can I use if I run out?”
• “How should I clean my plunger and case, and how often should I replace them?”
• “My lens doesn’t fit the peroxide case. What should I use?”
• “My dots are fading. Can you or the lab re-mark them?”
• “What should I do if I fall asleep in my lenses or get water in them?”