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    Scleral lenses for Stevens-Johnson syndrome: what the research shows

    Stevens-Johnson syndrome and toxic epidermal necrolysis can leave the eye surface scarred, dry, and painful for life. Here is what published studies found about scleral lenses for that long-term damage, including in children.

    By the Scleral Lens Team · Updated October 2, 2026 · 10 published sources cited

    The short answer

    In people living with eye damage from Stevens-Johnson syndrome (SJS) or toxic epidermal necrolysis (TEN), studies consistently report better vision, fewer symptoms, and large gains on quality-of-life questionnaires with scleral lenses. Not every eye can be fitted, because scarring can change the eye's shape too much, and in a long-term study of children, 30.6% failed treatment. Serious lens-related problems were rarely reported. The evidence is from retrospective case series at specialist centers, with no comparison groups.

    Key points

    • Vision and symptom scores improved in every series here.
    • Vision quality-of-life scores (NEI VFQ-25) rose by 24 to 42 points on average.
    • Some eyes can't be fitted because scarring has changed the eye's shape.
    • In children treated with PROSE, 30.6% failed treatment over about five years.
    • No serious lens-related adverse events were reported in the main series.

    How to read these numbers

    Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are severe reactions, usually to a medicine, that can scar the eye surface. The studies below are about the long-term (chronic) eye damage, not the acute illness. All are retrospective reviews from specialist centers, mostly of people who had tried other treatments first, and none had a comparison group.

    Two questionnaires appear often. The Ocular Surface Disease Index (OSDI) measures symptoms; lower is better. The NEI VFQ-25 measures how vision affects daily life; higher is better. Both are explained on the quality-of-life research page. Vision is in logMAR, where lower is better, or in Snellen fractions such as 20/40.

    Vision and symptoms in adults

    Study Who Design Vision[1][2][3] Symptoms and quality of life
    France, 2009 39 patients (67 eyes), mean follow-up 33.3 months Retrospective Better eye 0.73 → 0.50 logMAR at 6 months OSDI 76.9 → 37.1; NEI VFQ-25 25.1 → 67.4
    Boston (PROSE), 2015 86 patients (167 eyes), median follow-up 16 months Retrospective cohort Median 20/60 → 20/25, with no decline by the end of follow-up NEI VFQ-25 48 → 72 at 6 months
    Los Angeles (PROSE), 2014 27 eyes of 16 patients Retrospective 0.43 → 0.14 logMAR OSDI 70.4 → 37.4

    Sources: France[1], Boston[2], Los Angeles[3].

    Smaller and mixed studies point the same way:

    • Mixed surface disease, US, 2000. In a series of 76 eyes where 71% had SJS, 53% of eyes gained 2 or more lines of vision, and 92% of patients reported better quality of life through less light sensitivity and discomfort.[6]
    • Brazil, 2010, 10 eyes of 7 patients. Fitting succeeded in 90%, and all of those patients reported better symptoms and sight.[7]
    • SJS with keratoconus, India, 2017. In 5 eyes of 3 patients with both conditions, vision improved in all with scleral lenses.[8]

    In the Boston cohort, general health ratings also improved, from 57 to 65 out of 100 at six months.[2]

    Children

    • PROSE in children, Boston, 49 patients. Children were on average 6.4 years old when SJS or TEN began and 9.3 at their first PROSE visit. Median vision improved from 20/80 to 20/30 when the device was dispensed and was still 20/30 at the last visit, after an average of 5.45 years. Fifteen children (30.6%) failed PROSE treatment.[4]
    • Scleral lenses in children with surface disease, India, 91 eyes of 67 children. Most eyes (75) had SJS. Over an average of 40 months, vision improved significantly, 66.7% of SJS eyes showed less keratinization (a skin-like change of the eye surface), and no lens-related infections occurred.[5]

    For more on children and scleral lenses, see the guide to children and scleral lenses.

    Who can be fitted, and who keeps wearing them

    Not everyone can wear a scleral lens after SJS. In some eyes, scarring has changed the anatomy too much for a lens to be fitted.

    • In the French series, fitting failed in 3 of 39 patients.[1]
    • In the Los Angeles series, 19 patients were referred. Three were lost to follow-up during fitting, and 4 could be fitted in only one eye because anatomic changes prevented fitting the other.[3]
    • In the Boston pediatric study, 30.6% failed treatment.[4]

    We didn’t find adult studies reporting long-term dropout separately for SJS.

    Safety

    • No serious lens-related events. The French series of 39 patients reported no serious adverse events attributable to the scleral lenses.[1] The Indian pediatric study reported no lens-related infections; complications were the lens edge pressing into the conjunctiva (12% of eyes) and lens breakage (2.2%).[5]
    • Blood vessels into the cornea. In the small Indian series of SJS with keratoconus, one patient developed deep blood vessels in the cornea with prolonged wear. They regressed after wear time was reduced and the lens was changed to a more oxygen-permeable material. Another patient stopped because of redness and discomfort.[8]

    General scleral lens risks, including infection, apply too. See complications research.

    A group in Japan has studied a different design, a tear-exchangeable limbal rigid contact lens, in SJS and TEN. In a retrospective series of 53 eyes of 42 patients, average vision improved from 1.61 to 0.86 logMAR after three months and the NEI VFQ-25 score rose from 37.6 to 58.4, with no serious adverse events attributable to the lens.[9] In a later study of 50 eyes followed for an average of 4.3 years, redness of the conjunctiva improved and corneal blood vessel scores did not worsen in any eye.[10] These lenses are not scleral lenses, and they aren’t widely available everywhere. Ask your specialist which designs they use.

    For how SJS affects the eye and the full range of treatments, see the Stevens-Johnson syndrome condition page.

    Common questions

    Can scleral lenses help the eye problems left by Stevens-Johnson syndrome?

    For many people, studies suggest yes. In a Boston series of 86 patients treated with PROSE, median vision improved from 20/60 to 20/25, and vision quality-of-life scores rose from 48 to 72 out of 100 after six months. These are results from specialist centers in people who were fitted, without comparison groups.

    Can everyone with SJS wear a scleral lens?

    No. Scarring can change the eye surface so much that a lens can't be fitted. In a US series, 4 patients could be fitted in only one eye because of changes in the other, and in a French series, fitting failed in 3 of 39 patients. Your fitter will need to examine your eyes to know.

    Do scleral lenses work for children with SJS?

    In a Boston study of 49 children with SJS or TEN, followed for an average of 5.45 years, median vision improved from 20/80 to 20/30 and stayed improved. But 15 children (30.6%) failed treatment. Ask the fitter how your family will be supported with daily lens care.

    Are scleral lenses safe with SJS?

    In the French series of 39 patients followed for about three years, no serious adverse events attributable to the lenses occurred. One small report describes new blood vessels growing into the cornea with long wear, which regressed after wear time was reduced and the lens material changed. Regular checks with your fitter matter.

    Keep reading

    Scleral lenses for severe dry eye: what the research shows

    In people with severe dry eye or ocular surface disease that other treatments haven't controlled, studies find that scleral lenses reduce symptoms, improve vision, and improve quality-of-life scores. But the evidence comes almost entirely from single-clinic case series without comparison groups, often mixing several diseases. People with surface disease seem less likely to keep wearing the lenses long term than people with irregular corneas, and fogging of the fluid layer is a common complaint. For dry eye without other corneal problems, a 2024 review called the evidence sparse.

    Scleral lenses and quality of life: what the research shows

    Across keratoconus, transplants, and severe surface disease, studies using validated questionnaires consistently find that people report better daily visual functioning and fewer symptoms after being fitted with scleral lenses. Gains on the NEI VFQ-25 of about 20 to 40 points out of 100 are common, and symptom scores on the OSDI often fall by well over the amount researchers consider meaningful. But nearly all of these studies had no comparison group and measured only people who kept wearing their lenses. In the one randomized trial, people who already did well in corneal rigid lenses scored no better with scleral lenses.

    Scleral lenses for ocular GVHD: what the research shows

    In every study we found of people with ocular GVHD whose dry eye didn't respond to standard treatment, symptom scores dropped substantially and vision improved with scleral lenses. Between 8% and 22.6% stopped wearing them in the studies that reported it, over follow-up of up to about two years. No study reported serious problems clearly caused by the lenses. All of the evidence comes from case series and surveys without comparison groups, so it shows what happened to people who were fitted, not how lenses compare with other treatments.

    Scleral lens complications: what the research shows

    Serious complications from scleral lenses appear to be uncommon in published studies, but they do happen. Infections have been reported, often in eyes that were already fragile or where lens care slipped. The lens slightly reduces oxygen to the cornea, which matters most for eyes with a weakened inner corneal layer, such as some after a transplant. Studies on eye pressure are mixed and mostly short-term. Day-to-day problems such as broken lenses, deposits, and fogging are far more common than medical ones.

    Sources

    1. Tougeron-Brousseau B, Delcampe A, Gueudry J, et al. Vision-related function after scleral lens fitting in ocular complications of Stevens-Johnson syndrome and toxic epidermal necrolysis. Am J Ophthalmol. 2009;148(6):852-859.e2. doi:10.1016/j.ajo.2009.07.006 pubmed.ncbi.nlm.nih.gov
    2. Papakostas TD, Le HG, Chodosh J, Jacobs DS. Prosthetic replacement of the ocular surface ecosystem as treatment for ocular surface disease in patients with a history of Stevens-Johnson syndrome/toxic epidermal necrolysis. Ophthalmology. 2015;122(2):248-253. doi:10.1016/j.ophtha.2014.08.015 pubmed.ncbi.nlm.nih.gov
    3. Heur M, Bach D, Theophanous C, Chiu GB. Prosthetic replacement of the ocular surface ecosystem scleral lens therapy for patients with ocular symptoms of chronic Stevens-Johnson syndrome. Am J Ophthalmol. 2014;158(1):49-54. doi:10.1016/j.ajo.2014.03.012 pubmed.ncbi.nlm.nih.gov
    4. Wang Y, Rao R, Jacobs DS, Saeed HN. Prosthetic replacement of the ocular surface ecosystem treatment for ocular surface disease in pediatric patients with Stevens-Johnson syndrome. Am J Ophthalmol. 2019;201:1-8. doi:10.1016/j.ajo.2019.01.006 pubmed.ncbi.nlm.nih.gov
    5. Rajarajan M, Mathimaaran S, Subramanian M, et al. Visual and therapeutic outcomes of scleral lens in pediatric ocular surface diseases. Cornea. 2026. doi:10.1097/ICO.0000000000004285 pubmed.ncbi.nlm.nih.gov
    6. Romero-Rangel T, Stavrou P, Cotter J, Rosenthal P, Baltatzis S, Foster CS. Gas-permeable scleral contact lens therapy in ocular surface disease. Am J Ophthalmol. 2000;130(1):25-32. doi:10.1016/S0002-9394(00)00378-0 pubmed.ncbi.nlm.nih.gov
    7. Siqueira AC, Santos MS, Farias CC, Barreiro TR, Gomes JÁ. Scleral contact lens for ocular rehabilitation in patients with Stevens-Johnson syndrome [in Portuguese]. Arq Bras Oftalmol. 2010;73(5):428-432. doi:10.1590/S0004-27492010000500008 pubmed.ncbi.nlm.nih.gov
    8. Rathi VM, Taneja M, Dumpati S, Mandathara PS, Sangwan VS. Role of scleral contact lenses in management of coexisting keratoconus and Stevens-Johnson syndrome. Cornea. 2017;36(10):1267-1269. doi:10.1097/ICO.0000000000001310 pubmed.ncbi.nlm.nih.gov
    9. Sotozono C, Yamauchi N, Maeda S, Kinoshita S. Tear exchangeable limbal rigid contact lens for ocular sequelae resulting from Stevens-Johnson syndrome or toxic epidermal necrolysis. Am J Ophthalmol. 2014;158(5):983-993. doi:10.1016/j.ajo.2014.07.012 pubmed.ncbi.nlm.nih.gov
    10. Yoshikawa Y, Ueta M, Kinoshita S, Kida T, Sotozono C. Long-term benefits of tear exchangeable limbal-rigid contact lens wear therapy in Stevens-Johnson syndrome cases. Eye Contact Lens. 2023;49(6):247-253. doi:10.1097/ICL.0000000000000989 pubmed.ncbi.nlm.nih.gov

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