Can I use steroid or antibiotic drops while wearing scleral lenses?

Why the prescriber decides

Steroid and antibiotic drops are medicines prescribed for a reason: an infection, inflammation, a transplant, surgery or a flare of eye surface disease. The right timing depends on what’s being treated. A drop used after a healthy routine visit is a different situation from a drop treating an active infection.

So the first answer to “can I wear my lenses?” is always: ask the doctor who prescribed the drop, and tell your fitter. If those are different people, ask them to agree on a plan.

What the labels say

Labels give a starting point, and your prescriber may want something stricter:

• Pred Forte, a prednisolone steroid suspension, contains benzalkonium chloride. Its label says contact lenses should be removed before using it and may be reinserted 15 minutes after.^[1]
• Lotemax suspension, a loteprednol steroid, also contains benzalkonium chloride, and its label advises patients not to wear soft contact lenses while using it.^[2] That wording is about soft lenses; ask your doctor how it applies to your scleral lenses.
• Vigamox, a moxifloxacin antibiotic, says patients should not wear contact lenses if they have signs or symptoms of bacterial conjunctivitis.^[3]

Wearers commonly report doing their medicated drops with the lens out, before insertion or after removal, and that suspensions and preserved drops can leave a sticky film that fogs the lens. Some wait longer than the minimum and rinse the eye with sterile preservative-free saline before the lens goes in.

For how other prescription drops fit around lens wear, see eye drops with scleral lenses.

Drops in the bowl versus over the lens

There are three places a drop can go: over the lens, inside the bowl before insertion, or only when the lens is out. Medicated drops almost always belong in the third group.

Putting medicine inside the bowl holds it against your cornea for hours. Some specialists do prescribe this for specific problems. A review describes one approach for wounds that wouldn’t heal, using antibiotics and steroids in the fluid reservoir during lens wear; even so, an infection developed in 4 of 14 eyes in that report.^[4] That’s a prescribed treatment with close follow-up, chosen for a particular eye. It’s never something to try yourself.

Steroids and eye pressure

Steroid eye drops can raise the pressure inside the eye in some people. Pred Forte’s label warns that prolonged use may increase eye pressure in susceptible people, resulting in glaucoma, and that if it’s used for 10 days or longer, eye pressure should be routinely monitored.^[1] Lotemax’s label says the same about monitoring pressure if it’s used for 10 days or longer.^[2]

So if you’re on a steroid for more than a short course, expect pressure checks, and ask for them if they aren’t happening. Some wearers take steroids long term, for example after a corneal transplant, under regular monitoring. For whether scleral lenses themselves affect eye pressure, see can scleral lenses raise eye pressure and scleral lenses with glaucoma.

When there’s an infection

With a suspected or confirmed infection, many doctors keep the lens out until the eye has healed. Wearers who’ve been through this say they were told to leave the lens out of that eye until cleared, and to replace their case and tools afterward. See scleral lenses after a corneal ulcer.

A risky habit comes up again and again: treating a red, sore eye with leftover antibiotic or steroid drops, or drops bought abroad without an exam. Please don’t. Pred Forte’s label warns that prolonged steroid use may suppress the immune response and increase the hazard of eye infections,^[1] and only an exam can tell what’s going on.

What to ask your prescriber

• Can I wear my lenses during this treatment?
• How long after each drop before the lens goes in?
• Should the drop go in only with the lens out?
• If I’m on a steroid, when will my eye pressure be checked?
• What signs mean I should stop and call you?