Why children wear scleral lenses
Children are fitted with scleral lenses for many of the same reasons adults are: an irregular cornea from keratoconus, scarring, or a corneal transplant, or ocular surface disease that needs the protective layer of saline a scleral lens provides. Some wear them to correct vision after the eye’s natural lens has been removed (aphakia).[2]
The research is mostly from specialist centers, looking back at their own patients:
- A 21-year review at one center covered 209 children’s eyes. The average age at the start of treatment was 10.6 years. 70% of eyes were still wearing scleral lenses at the time of the review, 8% had stopped, and for 22% the status was unknown. Among those who stopped, difficulty with application and removal was the main reason.[1]
- Another clinic’s records covered 18 children aged 16 months to 14 years. Of them, 15 (83%) continued wearing their lenses over an average follow-up of about 9 months. Complications included one corneal graft rejection and one corneal abrasion linked to lens insertion.[2]
- A study of 67 children with ocular surface disease, aged 4 to 17, followed for at least a year, found vision improved and no lens-related infections occurred. The lens edge pressed into the tissue on the white of the eye (conjunctival impingement) in 12% of eyes, and 2.2% of eyes had a lens break.[4]
- A study of 25 eyes looked at quality of life after one month of scleral lens wear. Both the children’s and their parents’ quality of life scores improved compared with glasses.[3]
These are single-center studies, mostly without comparison groups, so they show what’s possible with experienced teams rather than what every child will experience.
Who handles the lenses
For younger children, a parent or caregiver usually does most of the handling. The centers above built that into their process. In the 21-year review, parents were involved in learning application and removal, and the team didn’t attempt to apply a lens until both the clinician and parents were confident they could get a good lid spread. Whether a parent or the child could manage the lenses was part of deciding whether a child was a good candidate.[1] In the quality-of-life study, both children and caretakers were trained in application and removal, with both a plunger and a stand, over a two-day dispensing visit. The authors named the need for multiple training visits as one of the main challenges.[3]
So expect your fitter to train you, not just your child, and to want more than one session.
Inserting a lens for a child
The basics are the same as inserting your own: a lens filled to the brim with preservative-free saline, a wide lid hold, the eye looking straight into the lens, and a smooth movement. See how to insert and helping someone else with their lenses for the helper’s view. What’s different with a child:
- Calm beats fast. A relaxed child keeps their eyes open more easily. Pick a quiet time, keep it routine, and stop if things are going badly.
- Positioning. Your fitter will show you a position that works for your child’s size, with their face parallel to the floor for insertion and you able to hold the lids steady.
- Explain what’s happening. Tell your child each step before you do it. Surprises make it harder.
- Practice both. Ask your fitter whether to start with insertion or removal, and make sure you’re confident with removal before you go home.
Building independence
There’s no set age for a child to take over. It depends on the child’s coordination, attention, and willingness. One approach is to hand over one step at a time:
- Your child washes and dries their hands while you prepare the lens.
- Your child holds their own lids while you insert.
- Your child fills and inserts, with you watching and doing the checks.
- Your child does the full routine, and you check in on cleaning and supplies.
Hygiene is the last thing to hand over completely, because it’s the part with the biggest consequences. Washing hands before handling lenses,[6] rubbing and rinsing lenses, using fresh solution every night, never topping off, and keeping water away from lenses all reduce the chance of infection.[5]
At school, sleepovers, and camp
- Backup glasses with a current prescription go everywhere. The FDA recommends always having a backup pair.[7]
- A small kit with saline, a remover, and a clean case for the school nurse or a trusted adult.
- No swimming in lenses. The FDA warns that swimming in contact lenses carries a risk of eye infection from bacteria in pools, hot tubs, lakes, and the ocean.[7]
- No sleeping in lenses, including naps on long car rides, unless your child’s eye doctor has said otherwise.
Common mistakes
- Learning insertion from videos instead of training with your child's fitter.
- Handing over the cleaning routine before your child can do every step reliably.
- Trying to insert a lens when your child is tired, upset, or rushed.
- Letting a child wear lenses longer than the schedule the fitter set.
- Sending a child to sleepovers or camp without a plan for removal and backup glasses.
Common questions
How young can a child wear scleral lenses?
There's no single age. In one clinic's records, children fitted with scleral lenses ranged from 16 months to 14 years old. Your child's eye doctor will weigh the eye condition, your child's cooperation, and whether someone at home can manage the lenses.
At what age can my child put the lenses in alone?
It depends on the child, not a birthday. Hand over steps as your child shows they can do them reliably, and keep supervising hygiene until they've got every step down. Ask your fitter to check their technique.
Can my child wear scleral lenses at school?
Usually, yes. Make a plan with the school for what happens if a lens comes out or an eye hurts, keep backup glasses there, and make sure your child knows to tell an adult about pain, redness, or blurry vision.
Are infections a bigger worry in children?
Clean handling matters at any age. In a study of 67 children with ocular surface disease who wore scleral lenses for at least a year, no lens-related infections occurred. That's one center's experience, so keep up the hygiene routine and know the warning signs.
Can my child swim or nap in their lenses?
No napping or sleeping in lenses unless the eye doctor says so, and lenses should come out before swimming. The FDA warns that swimming in contact lenses risks eye infection.