What you’re looking at
A scleral lens is a large, rigid gas permeable contact lens. Instead of resting on the cornea, it arches over it and lands on the white of the eye (the sclera), with a layer of saline filling the space underneath. In an international survey of scleral lens practitioners, the average lens was 16.2 mm across, with a range of 11.8 to 23.0 mm.[1] Most are worn for irregular corneas, such as keratoconus or after a corneal transplant, or for severe ocular surface disease.[1]
Because the lens is held on by a gentle seal, the usual ways of removing a soft lens don’t work, and force makes the seal tighter.
If it won’t come out
Most stuck lenses release with more lubrication, a short wait, and better placement of the plunger: lower on the lens, closer to the edge. If a few gentle attempts don’t work, stop. Contact on-call ophthalmology or optometry, or the patient’s own fitter, who can usually remove it quickly with the right tools.
Patients who wear scleral lenses can usually tell you which eye care practice fits them and how to reach it after hours. Some carry an emergency card with that information.
After the lens is out
- Store it safely. Use the patient’s lens case with sterile saline or their own disinfecting solution, and send it home with them. These lenses are custom-made.
- Expect poor vision without it. Many wearers see badly without their lenses even with glasses, because of the underlying corneal condition.
- Assess the eye. Pain, redness, blurred vision that doesn’t clear, light sensitivity and discharge are signs of irritation or infection in contact lens wearers.[3] Evaluate as you would for any contact lens wearer, and advise the patient not to put the lens back in until an eye care professional has checked the eye.
- Point them to their fitter. A lens that was hard to remove may be fitting too tightly, and the fitter needs to know.
This page is general information for medical staff. Follow your institution’s protocols and consult eye care whenever you’re unsure.
Common questions
How do I know it's a scleral lens and not a soft lens?
A scleral lens is rigid, clear and much larger than a typical contact lens. Its edge sits out on the white of the eye rather than near the colored part. Patients often tell you, or carry a card saying they wear them.
Can I pinch it out like a soft lens?
No. A scleral lens is rigid and held by a seal of saline, so pinching doesn't work and can scratch the eye. Use lubrication and a small plunger on the lower part of the lens.
What if there's no plunger available?
Ask whether the patient or a family member has one. Eye clinics, optical shops and on-call eye care usually do. Experienced wearers sometimes remove the lens by pressing the lid margins under its edges, but that takes practice and shouldn't be improvised on someone else's eye. If no tool is available and the lens must come out, contact eye care.
The patient is unconscious or sedated. Does the lens need to come out?
Scleral lenses are generally daily-wear lenses, and the FDA advises against sleeping in daily-wear lenses because it can raise the risk of infection or irritation. A patient who will be unconscious or sedated for a long time generally shouldn't keep them in. Remove them using the steps here, or contact eye care.
The patient can't see well after the lens is out. Is that a problem?
Often it's expected. Many scleral lens wearers have an irregular cornea, such as keratoconus or a corneal transplant, and see poorly without the lens even with glasses. Ask them what their vision is like without lenses before assuming something new is wrong.
What should I store the lens in?
The patient's lens case with sterile saline or their own disinfecting solution. Never tap water. These lenses are custom-made and expensive to replace, so make sure the lens goes home with the patient and is labeled right or left if you can tell.