What serum tears are
Autologous serum tears are eye drops made from your own blood. The aim is a drop that resembles natural tears more closely than artificial tears do, and they’re commonly used as a second-line treatment for dry eye.[1] A Cochrane review found that the evidence from randomized trials comparing serum with artificial tears was of low or very low certainty.[1] How serum tears are made and stored varies, because there are no universally accepted guidelines for their concentration, processing, or storage.[2]
Serum tears and scleral lenses work differently. Serum is meant to support the eye’s surface. A scleral lens keeps the cornea under a layer of saline and protects it from the air and the lids. Many people with severe dry eye, Sjögren’s, graft-versus-host disease, or neurotrophic keratitis use both. For how the two compare, see scleral lenses vs autologous serum drops.
Inside the lens: a prescription decision
Whatever goes in the bowl of a scleral lens sits against your cornea for hours, with very little fresh tear fluid moving in and out.[4] That’s why the bowl has the strictest rules of all: sterile, preservative-free saline, plus only what your doctor or fitter has prescribed. A report on Acanthamoeba infections in scleral lens wearers suggested the fluid reservoir could provide an environment for the organism to multiply, and stressed sterile, preferably single-use saline.[4]
Serum tears in the bowl fall squarely into “only if prescribed.” What wearers report is a genuine split among specialists:
- Some doctors prescribe it. Wearers describe being told to add a few drops of serum to each lens before topping up with saline, for example while healing a damaged cornea, and say their surface improved.
- Some advise against it. Other wearers were told by cornea and scleral lens specialists not to put serum in the lens because of infection risk, and to use serum before insertion and after removal instead.
- The details matter. Wearers note that their doctors weighed how the serum was packaged, for example single-use vials versus a bottle opened over several days.
Both groups are following their own doctor’s judgment about their own eyes. If you haven’t been told to put serum in your lens, don’t.
What the research shows
Published evidence on serum inside scleral lenses is very thin. One case report described a woman with severe neurotrophic keratopathy and a corneal wound that hadn’t healed after months of treatment. She was treated with continuous wear of a mini-scleral lens with serum in its fluid reservoir, along with serum drops, and the wound healed.[3] That was a single patient, under close specialist supervision, with continuous wear prescribed as treatment. It doesn’t show that everyday wearers should add serum to their lenses.
We didn’t find trials comparing serum in the bowl with saline alone. That gap is part of why specialists differ.
If your doctor prescribes serum in the bowl
- Use exactly the amount and schedule you were given.
- Follow the storage and use-by rules for your serum precisely.
- Use clean, dry hands and don’t let the vial tip touch the lens, your fingers, or your eye.
- Top up with fresh sterile saline as directed, from a new vial each time.
- If the lens stings, blurs more, or the eye gets red, take the lens out and call.
What wearers say
Experiences vary widely. Some wearers say serum in the bowl reduced stinging, inflammation, or fogging. Others found it made no difference to fog, or that it increased mucus and blur, and went back to saline alone. Many use serum heavily when their lenses are out, at night and first thing in the morning, and say their eyes feel better with both treatments working at different times of day.
What to ask your doctor and fitter
- Should my serum go in the lens, over it, or only when the lens is out?
- If in the lens, how many drops, and should I top up with saline?
- How should I store my serum, and how long can an opened vial be used?
- What signs mean I should stop and call you?
For other drops, see eye drops with scleral lenses.
Common questions
My doctor said yes. How much serum goes in the lens?
Whatever your doctor told you, and no more. Wearers report different instructions, often a few drops before topping up with sterile saline, but the amount, how often, and which vial to use are part of your prescription. If you're unsure, call and ask before you try it.
Can I use serum drops over my lenses while I'm wearing them?
Some wearers do, on their doctor's advice; others are told to use serum only before insertion and after removal. A drop over the lens won't reach the cornea under it, so ask your doctor when serum will do the most good for you.
Will I still need serum tears once I have scleral lenses?
Some wearers find they need less; many keep using serum when the lenses are out. Don't stop a prescription without talking to the doctor who prescribed it.
My serum stings in the lens. What should I do?
Take the lens out and rinse your eye with sterile saline. Then call the prescribing doctor and your fitter before trying it again. Some wearers find serum soothing in the bowl and others don't tolerate it.
Can I keep an opened serum vial for my midday refill?
Follow your serum's handling instructions exactly, including how long an opened vial can be used and how to store it. Wearers describe keeping serum frozen or refrigerated as their pharmacy directs. If in doubt, use a fresh vial or ask the pharmacy that made it.