Cleaning and disinfecting scleral lenses

Two jobs, not one

Cleaning removes what builds up on the lens during the day: protein, oils, makeup, and dust. Disinfecting kills the germs that remain. A scleral lens needs both.

Rubbing is the part people skip. The FDA tells contact lens wearers to rub and rinse their lenses as directed by their eye care professional.^[1] In a report of three cases of Acanthamoeba keratitis, a serious corneal infection, in scleral lens wearers with keratoconus, the authors listed not rubbing the lens during cleaning among the possible risks. They also flagged storing lenses overnight in saline instead of a disinfecting solution.^[4] That’s a small case series, not a measure of how often this happens, but the advice it points to is the same as the FDA’s.

Daily cleaners

A daily cleaner is a surfactant: a soap-like solution made for lenses. You rub with it when the lens comes out at night, then rinse it off. In an international survey of scleral lens practitioners describing 259 of their patients, 62% of those patients used a daily surfactant cleaner.^[5] Your fitter will tell you whether you need one and which to use.

Hydrogen peroxide or multipurpose?

Both kinds of solution clean and disinfect. Both help break up and remove trapped dirt, protein, and fatty deposits.^[2] In the same practitioner survey, 47% of patients used hydrogen peroxide disinfection.^[5]

Hydrogen peroxide systems (Clear Care is one example) are generally preservative-free, which may suit people who are sensitive to the preservatives in multipurpose solutions.^[2] They come with rules that matter:

• The peroxide must be neutralized before the lens touches your eye. In one-step systems, a disc built into the case does this; two-step systems use a neutralizing tablet.^[2]
• Use the new case that comes with each new bottle. An old case may not neutralize the peroxide.^[2]
• Wait the full soak time. For Clear Care, Alcon says at least 6 hours, or overnight.^[3]
• Never rinse a lens with peroxide or put it in your eye before it’s neutralized. That can cause stinging, burning, or eye damage.^[2]

Multipurpose solutions don’t need neutralizing, so the lens can be worn sooner. They contain preservatives, which some people are allergic or sensitive to.^[2] Use one made for your lens material, as your fitter directs.

Saline is not a disinfectant

Sterile saline is for rinsing and for filling the lens before insertion. The FDA is clear that saline is not for cleaning or disinfecting.^[1] A lens stored overnight in saline hasn’t been disinfected, however clean it looks. See saline and solutions for the full product kit.

Deep cleaning

Some fitters add a periodic deep clean on top of the nightly routine: for example, a weekly hydrogen peroxide soak for a lens that’s otherwise stored in multipurpose solution. Others prescribe a separate product for stubborn deposits. There’s no single schedule that suits everyone, so follow the one your fitter gives you and the label on whatever product they recommend.

Deposits are a common reason lenses get looked at. In a retrospective study of 157 eyes with keratoconus at one clinic, lens deposits were recorded in 8.9% of eyes.^[6] If your lenses start to look hazy or filmy despite good habits, that’s worth a call. It may mean your routine needs adjusting, or that a lens is wearing out. See when to replace your lenses.

Every time, no exceptions

• Wash your hands first.^[1]
• Fresh solution every night. Discard what’s left; never top off or reuse it.^[1]
• No water and no saliva on lenses or in cases.^[1]
• Check expiration dates. Don’t use solutions past their expiration or discard date.^[1]
• Follow the labels on every product, and the directions your fitter gives you.^[1]

For the full morning and night routine, see the daily routine guide. For looking after the case itself, see lens cases.