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    Wearing guide

    Dry eyes while wearing scleral lenses

    Scleral lenses keep the cornea bathed in saline, but the front of the lens and your eyelids still depend on your tears. When those struggle, you can feel it and see it.

    By the Scleral Lens Team · Updated October 2, 2026 · 8 published sources cited

    The short answer

    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.

    Before you start

    Time: Small changes today; a plan with your fitter over a few weeks.

    • Rewetting drops your fitter has approved for use with your lenses
    • Your daily cleaner
    • A notebook or phone to log symptoms

    Step by step

    1. Notice the pattern

      Is it smeary vision that clears for a second when you blink? Grittiness or burning by afternoon? Which eye, and how many hours in?

    2. Clean the lens properly

      Rub both sides with your cleaner every night as your fitter showed you. Oils and film on the front surface stop tears from spreading.

    3. Check what's on your hands and face

      Lotions, oily makeup, and creams can coat the lens. Wash with plain soap before handling lenses, and put makeup on after your lenses are in.

    4. Use only approved drops

      Ask your fitter which rewetting drops are safe to use over your lenses. Don't add any eye product without asking.

    5. Take a screen break

      If your eyes feel drier during long stretches of reading or screen work, look away and blink fully every so often.

    6. Ask about your eyelids and tear film

      Ask your fitter to check your meibomian glands and lid margins, and whether a dry eye treatment plan would help your lenses.

    These are general steps. If your fitter taught you differently, follow your fitter: your lens and eyes are theirs to know. Print the mirror cards to keep by your sink.

    Why dryness happens with a lens full of saline

    A scleral lens vaults over your cornea and holds a layer of saline against it all day. That’s why scleral lenses are used for some severe dry eye conditions. But the lens doesn’t replace your tears everywhere:

    • The front of the lens needs your tears to spread over it smoothly, the same way your cornea does. If they don’t, the surface dries in patches and vision looks smeary.
    • Your eyelids glide over the lens every time you blink, and the oil glands along their margins (meibomian glands) supply the oily part of your tears.
    • The white of the eye beyond the lens edge is still exposed.

    Poor front-surface wetting

    When tears bead up or break apart on the front of the lens instead of forming a smooth layer, light scatters and vision gets hazy. In a study of 48 habitual scleral lens wearers, those who reported fogging were more likely to have poor front-surface wetting seen at the slit lamp, while their lens fits were no different from those without fogging.[1]

    What helps:

    • Cleaning. Film and oils make wetting worse. Rub both sides of the lens with your cleaner every night, and keep lotions and oily products off your hands. The FDA advises putting makeup on after lenses are in.[7] See film and deposits on the lens.
    • A surface coating. In a small double-masked crossover trial, 21 scleral lens wearers with dry eye wore coated and uncoated versions of the same lens for 30 days each. The coated lens gave better comfort, fewer dry eye symptoms, less frequent foggy vision, and longer comfortable wearing time.[4] Ask your fitter how long a coating is expected to last and whether it changes how you clean the lens.

    Your eyelids matter

    Eyelid problems are common in scleral lens wearers. In a study of 49 habitual wearers, eyelid disease was common whatever the reason for lens wear. Among eyes being treated for ocular surface disease, 39% (7 of 18) had no expressible oil from their meibomian glands, compared with 11% (3 of 27) of eyes with an irregular cornea.[2]

    Dry eye and lens problems tend to travel together. In a survey of people with dry eye disease, 75% (50 of 67) of scleral lens wearers who answered reported midday fogging or clouding of vision.[3] In a study of 48 wearers, those with fogging had dry eye symptom scores in the severe range.[5]

    If your eyelids or tear film are part of the picture, treating them may help your lenses work better. Your fitter may treat this themselves or refer you to a dry eye specialist.

    Drops and products

    • Ask before you add anything. The FDA advises asking your eye care professional before using any medicine or eye product, even over-the-counter ones.[7]
    • Watch for preservatives. Preservatives such as benzalkonium chloride, common in multi-use eye products, can damage cells on the surface of the cornea and conjunctiva.[6] This matters most for anything that goes inside the lens, which must always be sterile, preservative-free saline.
    • Keep the case and tools clean. Dryness that comes with redness or discharge may not be dryness at all.

    Questions to ask your fitter

    • Is my lens surface wetting well? Would a coating help?
    • Do my meibomian glands or eyelids need treatment?
    • Which rewetting drops are safe with my lenses, and how often?
    • Would buffered saline or a different cleaner make a difference for me?
    • Should I plan a midday removal and refill on long days?

    Common mistakes

    • Using drops with preservatives over your lenses without asking your fitter.
    • Filling the lens with anything other than sterile, preservative-free saline.
    • Treating the lens but not the dry eye underneath it.
    • Assuming dryness means scleral lenses can't work for you, before your fitter has tried the fixes.

    Common questions

    If scleral lenses are used to treat dry eye, why do my eyes still feel dry?

    The lens keeps saline against your cornea, but the front of the lens, your eyelids, and the white of the eye beyond the lens edge still rely on your own tears. If your tear film or eyelid glands aren't working well, you can still feel dry and see smeary.

    What's a lens coating, and can I get one?

    Some scleral lenses can be given a surface treatment that helps tears spread across the front. In a small double-masked trial in wearers with dry eye, coated lenses were more comfortable than uncoated ones. Ask your fitter whether it suits your lens.

    Can I use any eye drops with scleral lenses in?

    Ask your fitter first. The FDA advises checking with your eye care professional before using any eye product, even over-the-counter ones. Preservatives in some drops can irritate the eye's surface.

    Does the filling saline matter for dryness?

    It needs to be sterile and preservative-free. Some people find buffered saline more comfortable. Ask your fitter before switching.

    Keep going

    Guide

    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.

    Guide

    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.

    Guide

    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.

    Sources

    1. Fogt JS, Schornack M, Nau C, Harthan JS, Nau A, Shorter E. Slit lamp findings in scleral lens wearers with and without subjective fogging. Eye Contact Lens. 2025;51(10):439-444. doi:10.1097/ICL.0000000000001204 pubmed.ncbi.nlm.nih.gov
    2. Harthan JS, Nau A, Shorter E, Nau CB, Schornack M, Fogt JS. Presence of eyelid disease in habitual scleral lens wearers. J Clin Med. 2026;15(9):3181. doi:10.3390/jcm15093181 pubmed.ncbi.nlm.nih.gov
    3. Shorter E, Nau CB, Fogt JS, Nau A, Schornack M, Harthan J. Patient experiences with therapeutic contact lenses and dry eye disease. Eye Contact Lens. 2024;50(2):59-64. doi:10.1097/ICL.0000000000001051 pubmed.ncbi.nlm.nih.gov
    4. Mickles CV, Harthan JS, Barnett M. Assessment of a novel lens surface treatment for scleral lens wearers with dry eye. Eye Contact Lens. 2021;47(5):308-313. doi:10.1097/ICL.0000000000000754 pubmed.ncbi.nlm.nih.gov
    5. Fogt JS, Nau C, Harthan J, Shorter E, Nau A, Patton K, Schornack M. Lens and solution properties in patients with and without midday fogging. Ophthalmic Physiol Opt. 2024;44(4):769-773. doi:10.1111/opo.13293 pubmed.ncbi.nlm.nih.gov
    6. Goldstein MH, Silva FQ, Blender N, Tran T, Vantipalli S. Ocular benzalkonium chloride exposure: problems and solutions. Eye (Lond). 2022;36(2):361-368. doi:10.1038/s41433-021-01668-x pubmed.ncbi.nlm.nih.gov
    7. U.S. Food and Drug Administration. Everyday Eye Care (contact lenses). Content current as of December 4, 2023. fda.gov
    8. U.S. Food and Drug Administration. Contact Lens Risks. Content current as of September 4, 2018. fda.gov

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