How to read these numbers
“Ocular surface disease” in these studies is a mix: Stevens-Johnson syndrome, graft-versus-host disease, Sjögren’s, exposure, neurotrophic disease, and dry eye with no named cause. Results for one group don’t always carry over to another. Almost every study enrolled people who had already tried several treatments without enough relief, so these are results for severe, hard-to-treat disease, not everyday dry eye.
The designs are mostly retrospective chart reviews or small prospective case series from one clinic, with no comparison group. Symptoms are usually measured with the Ocular Surface Disease Index (OSDI), where a lower score means fewer symptoms. Vision is usually reported in logMAR, where lower is better and 0.0 equals 20/20.
For how common dry eye is, see dry eye statistics. Two conditions with their own evidence have separate pages: ocular graft-versus-host disease and Stevens-Johnson syndrome.
Where scleral lenses sit in dry eye care
A 2024 review notes that the TFOS DEWS II report, the main international dry eye consensus, places scleral lenses at Step 3 of its management plan, an advanced step. The review describes interest in using scleral lenses for dry eye even when the cornea’s shape is normal, but found the evidence for that use sparse. It lists benefits reported in studies (surface healing, no tear evaporation under the lens, better vision) and challenges (more midday fogging, poor lens wetting, and variable satisfaction).[1]
Symptoms and vision
| Study | Who | Design | Main findings[2][3][4][6][5][7] |
|---|---|---|---|
| US tertiary center, 2014 | 212 people evaluated, 115 completed fitting | Retrospective, plus a mailed survey | Treatment goals met in all but 2 of 115; acuity 0.32 → 0.12 logMAR |
| US, 2000 | 76 eyes of 49 people; 71% of eyes had Stevens-Johnson syndrome | Retrospective, mean follow-up 33.6 months | 53% of eyes gained 2 or more lines; 45 of 49 people (92%) reported better quality of life; average wear 13.7 hours a day |
| Brazil, 2016 | 41 eyes of 25 people with moderate to severe dry eye | Prospective case series, 12 months | Acuity 0.703 → 0.406 logMAR; OSDI and general health (SF-36) scores improved significantly |
| China, 2025 | 22 eyes of 15 people with severe dry eye | Prospective, 1 month | OSDI 53.9 → median 10.4; share of eyes using steroid drops 63.6% → 13.6% |
| Iran, 2012 | 20 eyes of 13 people with severe dry eye | Prospective case series | 7 people took lenses home; 4 of them (7 eyes) were satisfied over about 18 months |
| US tertiary center, 2020 | 133 people evaluated, surface disease the main reason in 71% | Retrospective | Acuity in the surface disease group 0.3 → 0.1 logMAR |
Sources: US 2014[2], US 2000[3], Brazil[4], China[6], Iran[5], US 2020[7].
A few details worth knowing:
- People had tried a lot first. In the 2014 US series, people had tried an average of 3.2 other treatments before scleral lenses. Fitting took an average of 3 visits and 1.4 lenses per eye.[2]
- Healing of surface defects is reported, but not in everyone. In the 2000 series, open defects on the corneal surface healed in 8 of 15 eyes and were unchanged in the other 7.[3]
- Tear tests improved in one study. In the Brazilian series, tear saltiness (osmolarity) and surface staining scores improved after 12 months of wear.[4]
- Medicines were reduced but not stopped. In the Chinese study, the average number of medicine types per eye fell from 2.82 to 1.32 after one month.[6]
- Not everyone who tries goes on to wear them. In the Iranian series, only 7 of 13 people ordered lenses after fitting.[5]
Quality of life
In a prospective study of 101 consecutive patients at the Boston Foundation for Sight, the average NEI VFQ-25 composite score (a vision quality-of-life questionnaire scored out of 100) rose from 57.0 to 77.8 after six months. Overall gains were similar for surface disease and for irregular corneas, but people with surface disease improved more on pain, role difficulties, and dependency, while people with irregular corneas improved more on vision-related items.[8]
How these questionnaires work, and how to read the score changes, is on the quality-of-life research page.
Who keeps wearing them
Long-term data are scarce. The clearest figure comes from a five-year review at the Boston Foundation for Sight: of 121 patients with five-year data, 64% of those treated for ocular surface disease were still wearing their PROSE devices, compared with 84% of those treated for a distorted cornea.[9] The authors noted this difference did not hold for every surface disease subgroup.
Safety and day-to-day problems
- Corneal swelling and eye pressure. In a retrospective study of 46 eyes with surface disease (graft-versus-host disease, Stevens-Johnson syndrome, Sjögren’s, or general dry eye), central corneal thickness rose by 1.01% after lens wear, a small but statistically significant change. Eye pressure measured after removal did not change significantly.[10]
- Debris in the fluid layer. In 13 eyes with surface disease, the cloudy area of the fluid reservoir grew from 0.6% to 24% over four hours on the first day, and contrast sensitivity fell. After a month of wear, both had improved.[11]
- Fogging. In a 2026 prospective study that included people with dry eye, keratoconus, trauma, and transplants, 51.3% of patients reported midday fogging.[12]
- Complications in the 2014 series. Three people had complications during wear; all resolved without loss of vision, and all could resume wearing the lenses.[2]
- Extended wear in fragile eyes. In an early series of 875 eyes, corneal infection occurred in 4 of 22 eyes treated with extended scleral lens wear for persistent surface defects after a transplant.[13] That is a specialist, closely supervised use, not ordinary daily wear, but it is a reminder that fragile corneas need careful monitoring.
The full picture on infection, swelling, and pressure is on the complications research page.
For how a scleral lens helps a dry surface and what else is available, see the severe dry eye condition page and the Sjögren’s syndrome page.
Common questions
Do scleral lenses work for dry eye?
For severe dry eye and ocular surface disease that hasn't responded to other treatments, the studies here all report less discomfort and better vision. In a US tertiary-center series, treatment goals were met in all but 2 of the 115 people who completed fitting. The evidence is from case series without comparison groups, so it can't say how scleral lenses compare with other treatments.
Are scleral lenses a first treatment for dry eye?
No. A 2024 review notes that the international TFOS DEWS II report places scleral lenses at Step 3 of its dry eye management plan, an advanced step after simpler treatments. The same review found the evidence for using them in dry eye without other corneal problems sparse.
How long do people with dry eye keep wearing scleral lenses?
In a five-year follow-up at one PROSE center, 64% of people treated for ocular surface disease were still wearing their devices, compared with 84% of those treated for a distorted cornea.
Is fogging worse in dry eye?
Reviewers list increased midday fogging as one of the challenges of fitting scleral lenses in dry eye. In a small study of 13 eyes with surface disease, debris in the fluid layer built up over four hours of wear and reduced contrast sensitivity, though both improved after a month.
Do scleral lenses replace my dry eye drops?
Not necessarily. In a one-month Chinese study of 22 eyes, the average number of medicines per eye fell, but it did not fall to zero. Any change to your medicines is a decision for the doctor managing your dry eye.