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    Wearing guides

    Wearing scleral lenses

    Step-by-step help with the part most new wearers find hardest: getting the lens in, getting it out, and fixing what goes wrong in between. Your own fitter's instructions always come first.

    Guides

    1 How to insert a scleral lens Fill the lens to the brim with preservative-free saline, look straight down with your face parallel to the floor, hold both lids wide at the lashes, and bring the lens straight up to your eye in one smooth motion. Then check for bubbles every time. 2 How to remove a scleral lens Put a drop or two of artificial tears in your eye first. Then press the small removal plunger onto the lower third of the lens, never the center, until it grips, and pull outward. Do it over a towel, and clean the lens right away. 3 Filling solution and air bubbles Fill the lens with preservative-free saline from a fresh single-use vial until it domes slightly above the rim, and keep your face parallel to the floor as it goes in. If you see a bubble, take the lens out, refill it, and put it back in. Don't wait it out. 4 What to do when a scleral lens is stuck Stop pulling. Put a drop or two of artificial tears in your eye, wait a minute, and try again with the plunger on the lower third of the lens, not the center. If it still won't come out after a few gentle tries, call your eye doctor rather than forcing it. 5 Your first two weeks with scleral lenses Expect it to be slow and awkward at first. That's normal. Practice every day at a calm time, follow your fitter's wearing schedule exactly, do the three checks after every insertion, and keep notes for your follow-up. Decide after two to three weeks, not after two to three days. 6 The scleral lens daily routine Mornings: wash your hands, inspect and rinse the lenses, fill with preservative-free saline, insert, and empty and air-dry the case. Nights: remove over a towel, rub each side with your cleaner, and store in fresh solution, never topping off. Replace your case every three months. 7 Cleaning and disinfecting scleral lenses Every night, rub each side of the lens with your daily cleaner, rinse it, then store it in fresh disinfecting solution in a clean case. Hydrogen peroxide and multipurpose solutions both disinfect, but they're used differently and aren't interchangeable. Use the products your fitter chose, follow the labels, and do any deep cleaning on the schedule they set. 8 Inserters and removers, compared An inserter has a large cup that holds the filled lens; a remover has a small cup that grips the edge of the lens to lift it off. Options for insertion include plunger inserters (with or without a see-through hole), finger ring tools, and stands that free up both hands. Ask your fitter before switching tools, keep them clean and dry, and never rinse them with water. 9 Saline and solutions: your product kit You'll usually need four things: sterile, preservative-free saline to fill the lens, a daily cleaner to rub it with, a disinfecting solution to store it in, and possibly artificial tears your fitter approves. They are not interchangeable. Use the specific products your fitter recommends, keep each in its own bottle, and check the expiration dates. 10 Your wearing schedule Follow the wearing schedule your fitter gives you, even when the lenses feel fine: scleral lenses can feel comfortable past the point that's safe for your eye. Build up as they direct, take the lenses out before any sleep, including naps, and ask whether a planned midday removal and refill would help you. 11 Traveling with scleral lenses Pack at least twice the saline vials you expect to use, a backup of every solution, a spare case, plunger, and inserter, and your glasses. Keep solutions in their original bottles: never pour them into travel containers. At US airports, declare medically necessary liquids at security. On flights, wearing your glasses is usually the easier choice. 12 Midday fogging First work out where the fog is. If blinking or a rewetting drop clears it for a moment, it's probably on the front of the lens. If it doesn't, it's probably in the saline behind the lens: take the lens out, rinse, refill with fresh saline, and reinsert. Either way, tell your fitter: changes to the fit, a lens coating, or treating dry eye can all help. 13 Eye pain: when to get help If you have eye pain, worsening redness, new sensitivity to light, discharge, or blurry vision that doesn't clear with the lens out, remove the lens and don't put it back in. Store it in its case and bring it with you. Call your fitter or eye doctor right away, including their after-hours line. If you can't reach them, go to urgent care or an emergency room and tell them you wear scleral lenses. 14 Children and scleral lenses Yes, children can wear scleral lenses, and studies at specialist centers report that most children who were fitted kept wearing them. A parent or caregiver usually learns to insert and remove the lenses alongside the child, and fitters often won't start until both are confident. Plan on extra training visits, take over the hygiene and supply routine yourself at first, and hand over steps gradually as your child is ready. 15 Helping someone else with their lenses Get trained by the wearer's fitter, ideally at a visit together. Wash and dry your hands, and set up so the wearer can sit with their face parallel to the floor while you hold their lids at the lash line and bring the filled lens straight up. For removal, use a drop of artificial tears and the small plunger on the lower third of the lens. Learn the warning signs, and if the wearer has pain, worsening redness, light sensitivity, discharge, or blurry vision that doesn't clear, remove the lens and call their eye doctor today.

    Quick fixes

    Short answers for when something specific goes wrong.

    Blinking or flinching as the lens comes close It's a normal reflex, and it fades with practice. Hold your lids right at the lash line so they can't close, keep both eyes open, look into the center of the lens as it comes up, and move in one smooth, steady motion. If you've tried several times, rest and come back to it. When the lens lands off-center Don't try to push it into place. Take the lens out with your removal plunger, refill it to the brim, and insert again, looking straight into the center of the lens as it comes up. If your lenses often sit off-center during the day, tell your fitter. Blurry right after insertion Check for a bubble first: shine a light and look in the mirror. Then make sure the right lens is in the right eye, and look for film, smudges, or specks on the lens. Most of the time, removing the lens, cleaning or rinsing it, refilling to the brim, and reinserting fixes it. Right and left lenses mixed up If both eyes are suddenly blurry or one lens feels wrong, the lenses may be in the wrong eyes. Take them both out, swap them, and do the three checks. To prevent it: always do the same eye first, and keep each lens in its own marked side of the case. Dropped your scleral lens? Stop moving and look before you step. Pick the lens up gently, then don't put it straight back in: rinse it with fresh solution and clean and disinfect it fully, never with water. Check it for chips or cracks before wearing it again. If it's damaged, wear your glasses and call your fitter. Can't see the mirror without your glasses? Get closer and brighter: a lighted magnifying mirror on the counter makes a big difference. Do the eye that sees worse first, so your better eye helps you aim; then the first lens helps you see for the second. And rely on feel and routine as much as sight. The saline spills before the lens gets there Keep the inserter upright and your face parallel to the floor, so the lens comes straight up instead of at an angle. Move steadily, not quickly. If saline spills, refill to the brim before you try again, rather than going ahead with a half-empty lens. Your lids keep slipping out of your fingers Dry your hands completely, hold each lid right at the base of the lashes, and keep holding until the lens has settled. Use your non-dominant hand for both lids, or one finger from each hand if that's easier. If they still slip, an insertion stand frees up both hands. Small eye opening or deep-set eyes Hold the lids wider, at the lash line, and tuck your chin so your face is level. An insertion stand, which frees both hands for your lids, may help. If it still won't fit through, tell your fitter: scleral lenses come in a range of sizes, and they can choose a different one. The plunger won't grip Make sure you're using the small remover, not the inserter, and that its cup is clean, soft, and uncracked. Place it on the lower third of the lens and press gently until it grips. If it's old or stiff, replace it. If it still slips most days, tell your fitter. The lens popped out during the day Find the lens and keep it safe. Don't wet it with water or saliva. If you have clean hands, fresh saline, and your inserter, you can rinse it, refill it, and reinsert. If not, store it in a clean case with fresh solution and wear your glasses. If it happens more than once, tell your fitter. Redness around the lens edge Redness in a ring around where the lens edge sat, especially by evening or with a feeling of pressure, can mean the lens is fitting too tightly. Tell your fitter: they can adjust it. If the redness is getting worse quickly, or comes with pain, discharge, light sensitivity, or blurry vision, remove the lens and call your eye doctor today. Shaky hands Sit down at a table and brace both elbows on it, so your hands have something solid under them. Take a slow breath before you bring the lens up. If a tremor or arthritis makes it hard, ask your fitter about an insertion stand, which holds the lens still for you, or about training a family member or caregiver to help. It takes me forever every morning Slow at first is normal, and most people get much faster with daily practice. Set everything out the night before, use the same spot and order every day, and practice when you're not in a hurry. If it's still taking a long time after a few weeks, tell your fitter: a different tool or a lens change can help. Looking after your lens case Use the case that matches your disinfecting solution: hydrogen peroxide cases have a built-in neutralizer and can't be swapped for a regular case, and a new one comes with each bottle. Empty, rinse with fresh solution, and air-dry the case upside down every morning. Never use water. Replace it every three months, or sooner if your fitter says so. Swimming, showers, and water Take your lenses out before swimming, hot tubs, or any time your eyes will be in water, and shower and wash your face before you insert or after you remove them. If water does get on a lens, take it out, then clean and disinfect it fully before wearing it again. Watch your eye, and call your eye care professional if it becomes red, painful, or blurry. Makeup and skin care with scleral lenses Spray products first, then wash your hands with plain soap, then insert your lenses, then apply makeup. At night, take your lenses out before you remove your makeup. Choose oil-free products near your eyes, and keep lotions and creams off your hands when you handle lenses. When to replace your scleral lenses There's no fixed replacement date. In one hospital study, the average time between lens orders was about two years, with a wide range. Signs a lens may be wearing out include haze or film that cleaning won't remove, scratches or chips, vision that's less sharp than when the lens was new, and more end-of-day discomfort. Don't wear a chipped or cracked lens: switch to glasses and call your fitter. Your scleral lens emergency kit Pack a small zippered pouch with a few single-use saline vials, a spare removal plunger and inserter, a clean case, a small bottle of the disinfecting solution your fitter approves, and your glasses. Keep one wherever you spend long stretches: your bag, your desk, your car. Check the dates every month. Halos, glare, and ghosting First rule out the simple things: a bubble, a dirty or filmy lens, or lenses in the wrong eyes. If halos or ghosting persist with a clean, well-filled lens, tell your fitter. The lens may be sitting slightly off-center, or your eye may have optical irregularities a standard lens doesn't fully correct. Fitters can change the lens design to recenter it or add more advanced optics. Vision that changes during the day Start by telling fluctuation from fogging. Fogging looks hazy or milky and usually improves when you remove, rinse, and refill the lens. Fluctuation is a change in focus that a fresh fill doesn't fix. It can come from the lens settling onto the eye over the first hours, or from the cornea swelling slightly under the lens. Both are things your fitter checks for and can adjust, so note when it happens and tell them. Discomfort and lens awareness A well-fitted scleral lens shouldn't hurt. If it feels wrong right after insertion, check for a bubble or debris and reinsert. Pressure that builds during the day, a red ring where the edge sits by evening, or a lens that's hard to remove can mean the fit is too tight, which your fitter can adjust. Pain, worsening redness, light sensitivity, discharge, or blurry vision that doesn't clear mean remove the lens and call your eye doctor today. Dry eyes while wearing scleral lenses Dryness with scleral lenses usually comes from the front of the lens not staying wet, often because of dry eye or problems with the oil glands in your eyelids. Signs are smeary vision that clears briefly when you blink, and grittiness late in the day. Clean the lens well, ask your fitter which drops are safe to use over your lenses, and ask about a surface coating and about treating your eyelids and tear film. Film and deposits on the lens Hold the lens up to the light: a hazy or greasy film is usually a buildup of protein, oils, or products from your hands and face. Rub both sides with your daily cleaner every night, keep lotions and makeup away from the lens, and ask your fitter whether a hydrogen peroxide system or a stronger cleaner would help. If cleaning doesn't clear the film, or the lens is scratched, tell your fitter: it may need replacing. Long nails and scleral lenses Hold your lids with the flat pads of your fingers, not your fingertips, so your nails point away from your eye. Let the tools do the work: the inserter and removal plunger mean your nails never need to touch the lens on your eye. Scrub under your nails with soap and a nailbrush before handling lenses. If your nails keep getting in the way, ask your fitter about an insertion stand, or consider keeping the nails on your lid-holding fingers shorter. Arthritis and limited dexterity Set up so your hands do as little fine work as possible: sit at a table, brace your elbows, and use an insertion stand that holds the lens so your hands only need to hold your lids. Ask your fitter which tools suit your grip, and practice at the time of day your hands work best. If handling is still a struggle, your fitter can train a family member or caregiver to help. Raise it early: handling is one of the main reasons people give up on scleral lenses.

    Solutions masterclass

    Which solution, when?

    Saline, cleaner, peroxide, multipurpose, drops: what each one is for, what never touches your eye, and what to try when a product isn’t working for you.

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    Print and keep by your mirror

    One-page insertion and removal cards, a 14-day practice log to bring to your follow-up, and a wallet card that tells emergency staff how to remove your lenses.

    Get the printables Emergency wallet card

    Feeling overwhelmed?

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