Awareness versus discomfort
It helps to separate three things:
- Awareness: you can tell the lens is there, especially when you think about it or look in certain directions. Ask your fitter what to expect, particularly in the first weeks.
- Discomfort: scratchiness, burning, dryness, or a feeling of pressure. This isn’t something to tough out. It usually has a cause your fitter can find.
- Pain: sharp, aching, or worsening pain, especially with redness, light sensitivity, discharge, or blurry vision. That’s a reason to remove the lens and call today.
Discomfort is common enough that it’s a major reason people stop wearing scleral lenses. In a study of 120 veterans fitted with scleral lenses, 20.0% had ocular irritation while wearing them.[1] In a year-long study of 95 wearers, discomfort was the reason for 19% of the people who stopped.[2] The upside is that many causes of discomfort are fixable.
When it starts tells you a lot
Right after insertion. Discomfort the moment the lens goes in usually means something is trapped: a bubble, lint, or a speck of debris. The cornea is one of the most densely innervated and sensitive tissues in the body,[4] so even small things can feel big. Take the lens out, check it, refill from a fresh vial, and reinsert. If it still hurts, leave it out.
A damaged lens. A chip or crack can make a lens feel scratchy, and a damaged lens shouldn’t go in your eye. Inspect your lens against the light before every insertion. In a study of 157 keratoconus eyes wearing scleral lenses, broken lenses were the most common lens-related problem, recorded in 26.1% of eyes.[3] If you find damage, don’t wear the lens; call your fitter.
Building through the day. If the lens starts comfortably but you feel pressure building over the hours, see a ring of redness where the edge sat by evening, or find the lens hard to remove, the fit may be too tight. Redness around the edge is covered in more detail in redness after removal.
Dryness or grittiness late in the day. This is often about the tear film on the front of the lens, or dry eye underneath it all. See dry eyes while wearing scleral lenses.
With hazy vision. Discomfort together with cloudy vision a few hours in can come with fogging. See midday fogging.
Signs the fit may be too tight
- Pressure that builds through the day.
- A red ring around where the lens edge sits, by evening or after removal.
- A lens that’s increasingly hard to remove, even with drops and good technique.
None of these is something you need to put up with. The white of the eye often isn’t perfectly round, and fitters can reshape the landing zone (the part of the lens that rests on the white of the eye) to follow its contour, change the edge, or adjust how much the lens vaults the cornea.
What your fitter can change
In a study of keratoconus patients who wore scleral lenses for at least a year, lens intolerance was recorded in 7.6% of eyes, and refits were the most common way problems were managed, making up 54.0% of interventions.[3] Changing the lens is a routine part of scleral lens care, not a sign that something went wrong.
To help your fitter, be specific: which eye, where on the eye, what it feels like, how many hours in, and whether it eases once the lens is out.
Common mistakes
- Wearing through pain because you've been told scleral lenses take getting used to.
- Ignoring a lens that feels scratchy without checking it for chips or cracks.
- Going past the wearing time your fitter set because the lens still feels comfortable.
- Waiting for your next routine visit when discomfort is getting worse.
Common questions
Should I be able to feel my scleral lenses?
Ask your fitter what to expect for your eyes. Many people notice their lenses at first, but a lens shouldn't hurt, and discomfort that builds through the day or keeps coming back is worth reporting.
Why does a tiny bubble or speck feel so big?
The cornea is one of the most densely supplied with nerves, and most sensitive, tissues in the body. Small things under the lens can feel large.
Can my fitter really fix a lens that's uncomfortable?
Often, yes. In a study of keratoconus patients wearing scleral lenses, refitting was the most common way problems were managed. Fitters can change how the lens lands on the white of your eye, how much it vaults the cornea, and the shape of its edge.
My lens feels fine, so can I wear it longer than my schedule says?
No. Scleral lenses can feel comfortable past the point your fitter wants you to stop. Stick to the schedule, and ask before you extend it.