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    Question

    Can scleral lenses help dry eye from rheumatoid arthritis?

    Dry eye is the most common way rheumatoid arthritis affects the eyes. Scleral lenses are one option when drops aren't enough. Arthritis in your hands adds a practical challenge worth planning for.

    By the Scleral Lens Team · Last reviewed October 2, 2026 · 6 published sources cited

    The short answer

    They can, when dry eye from rheumatoid arthritis doesn't respond enough to drops and other treatment. A scleral lens holds a reservoir of fluid over the cornea and reduces evaporation, and reviews list it as an option for persistent symptoms. It doesn't treat the arthritis or the more serious eye inflammation RA can cause, such as scleritis, which needs urgent medical care. Stiff or painful hands can make insertion and removal harder, but tools and training help many people.

    Key points

    • Dry eye is the most common eye problem in rheumatoid arthritis.
    • Scleral lenses are an add-on for dry eye that persists despite treatment, not a first step.
    • Scleritis and peripheral ulcerative keratitis are emergencies that a lens can't treat.
    • Hand deformities can make lens handling hard, and handling problems are the top reason people stop.

    How rheumatoid arthritis affects the eyes

    Dry eye disease is the most frequent eye problem in rheumatoid arthritis (RA). It’s often a mix of two problems: too little watery tear production, and faster evaporation when the eyelid oil glands don’t work well (meibomian gland dysfunction).[1]

    RA can also cause less common but serious inflammation: scleritis, inflammation of the white of the eye, and peripheral ulcerative keratitis (PUK), in which the edge of the cornea thins and breaks down. Both generally need treatment with medicines that act on the whole body.[1] Scleritis typically causes severe, dull pain that may spread to the face and is often worse at night. PUK usually comes with light sensitivity, redness, tearing and severe pain, and can thin the cornea quickly.[1]

    Some people with RA also have Sjögren’s syndrome, which causes marked tear deficiency.[1] See scleral lenses for Sjögren’s syndrome.

    Where scleral lenses fit in

    Dry eye in RA is first treated with lubricating drops (preservative-free when used more than four times a day), anti-inflammatory drops, and lid hygiene with warm compresses when the oil glands are involved. For symptoms that persist despite that, a 2026 review lists moisture-retaining eyewear and scleral lenses, which reduce evaporation and hold a protective reservoir of fluid over the cornea.[1]

    We didn’t find studies of scleral lenses in RA specifically. In dry eye more broadly:

    • At one clinic, people using a scleral device called PROSE, most often for dry eye, saw symptom scores improve by an average of 54.7%. That figure comes from the 43 of 134 patients who completed a follow-up survey, so it may not represent everyone.[2]
    • In a survey of people with dry eye, 75% of scleral lens wearers reported midday fogging or clouding, and 72% spent more than 20 minutes a day on dry eye care.[3]

    So scleral lenses can help a great deal, but they add a routine, and they don’t replace the rest of your dry eye treatment. More detail is on scleral lenses for severe dry eye.

    When a lens isn’t the answer. In PUK, immediate protection of the eye surface can include stopping contact lens wear, alongside urgent medical treatment.[1] A scleral lens doesn’t treat scleritis or PUK, and these conditions need your eye doctor and rheumatologist first.

    Arthritis in your hands

    Inserting and removing a scleral lens takes fine finger control. A 2025 review names finger deformities, essential tremor and peripheral neuropathy as conditions that can make it much harder.[4] Handling matters: in a study of 120 veterans, difficulty with insertion and removal was the most common reason people stopped wearing scleral lenses, accounting for 53.7% of those who stopped.[5]

    Help is available. The same review describes tools such as an inserter with a built-in light and a one-finger applicator that gives a stable platform for insertion.[4] Stands can hold the lens so you can use both hands on your eyelids. Practical guides:

    Tell your fitter about your hands at the first visit, so training can be planned around them. If your hands are worse in the morning, ask whether you can practice at the time of day they work best.

    Common questions

    Should I try scleral lenses before drops and other dry eye treatments?

    Usually not. In rheumatoid arthritis, dry eye is first treated with lubricating drops, anti-inflammatory drops, and lid care when the oil glands are involved. Scleral lenses are generally an add-on when symptoms persist. Your eye doctor will guide the order.

    Can I wear scleral lenses if I've had scleritis?

    That's a decision for your eye doctor, ideally together with your rheumatologist. A scleral lens rests on the white of the eye, which is where scleritis happens, and active scleritis needs medical treatment first. Don't restart lenses after a flare until you've been told it's safe.

    My RA medicines suppress my immune system. Does that matter?

    Ask both your rheumatologist and your fitter. Tell your fitter about every medicine you take, and tell your rheumatologist that you wear lenses, so each can factor that into your care. Careful lens hygiene and prompt attention to symptoms matter for every wearer.

    Can someone else put my lenses in for me?

    Some people rely on a partner or carer. If that's your plan, bring them to the training visit so they learn the technique, hygiene steps, and removal method directly from your fitter.

    Keep reading

    What is PROSE treatment?

    PROSE is a customized scleral lens treatment from BostonSight, based in Needham, Massachusetts. The device itself is a scleral lens: a gas permeable dome filled with saline that vaults over the cornea and rests on the white of the eye. What sets PROSE apart is its proprietary design software and a structured treatment program with intensive training. It's mainly used for people with severe ocular surface disease or irregular corneas who haven't done well with other options.

    Am I too old for scleral lenses?

    Probably not. In a study of 120 veterans with an average age of 56.7, age didn't differ between people who kept wearing scleral lenses and those who stopped. What does matter is handling: difficulty putting lenses in and taking them out was the most common reason people stopped, and conditions that affect the hands or nervous system made stopping more likely. Your fitter will also check your cornea and the tissue the lens rests on, which change with age.

    Can I wear scleral lenses with blepharitis or MGD?

    Yes, most people can, but treating the eyelids is part of making the lenses work. Blepharitis and meibomian gland dysfunction (MGD) disturb the tear film over the front of the lens, which can make vision hazy a few hours into the day. Research links this front-surface fogging to poor wetting of the lens surface and to eye surface inflammation. Lid treatment, a lens surface treatment, and sometimes a planned midday clean and refill can all help.

    Can scleral lenses help with light sensitivity?

    Sometimes. If your light sensitivity comes from a damaged, dry, or irregular front surface of the eye, a scleral lens may reduce it by covering and bathing the cornea and by smoothing the glare and halos an irregular cornea causes. A standard scleral lens is clear, though, so it doesn't block light, and it won't help light sensitivity that comes from inside the eye, the nerves, or migraine. New light sensitivity while you're wearing scleral lenses can be a sign of a problem: remove the lens and call your eye doctor.

    Can I wear scleral lenses if I have ocular rosacea?

    Often, yes, but treating the rosacea comes first and continues alongside the lens. Ocular rosacea inflames the eyelid margins and oil glands and can, in more severe cases, damage the cornea. Eyelid disease of this kind is common among scleral lens wearers and is linked to blurry, fogged vision through the lens. A scleral lens may help if rosacea has left your cornea scarred or your eye very dry, but we found no studies of scleral lenses in ocular rosacea specifically.

    Sources

    1. Forestier MG, Calderón RM, Oliver A. An overview of rheumatoid arthritis-associated dry eye disease, scleritis, and peripheral ulcerative keratitis. J Clin Med. 2026;15(9):3207. doi:10.3390/jcm15093207 pubmed.ncbi.nlm.nih.gov
    2. Asghari B, Brocks D, Carrasquillo KG, Crowley E. OSDI outcomes based on patient demographic and wear patterns in prosthetic replacement of the ocular surface ecosystem. Clin Optom (Auckl). 2022;14:1-12. doi:10.2147/OPTO.S337920 pubmed.ncbi.nlm.nih.gov
    3. Shorter E, Nau CB, Fogt JS, Nau A, Schornack M, Harthan J. Patient experiences with therapeutic contact lenses and dry eye disease. Eye Contact Lens. 2024;50(2):59-64. doi:10.1097/ICL.0000000000001051 pubmed.ncbi.nlm.nih.gov
    4. Rodriguez-Garcia A, Jimenez-Perez JC, Ruiz-Lozano RE, Bustamante-Arias A, Barcelo-Canton RH. 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. Kanakamedala A, Salazar H, Campagna G, et al. Outcomes of scleral contact lens use in veteran population. Eye Contact Lens. 2020;46(6):348-352. doi:10.1097/ICL.0000000000000671 pubmed.ncbi.nlm.nih.gov
    6. U.S. Food and Drug Administration. Contact Lens Risks. Content current as of September 4, 2018. fda.gov

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