Long nails and scleral lenses

Two risks: scratches and germs

Long nails raise two separate concerns with scleral lenses.

Scratches. Fingernails are a recognized cause of corneal abrasions, which are scrapes on the clear front surface of the eye.^[1] During insertion and removal, your fingers are right at your lash line, so how you hold your lids matters.

Germs under the nails. The area under the nails holds more microbes than other parts of the hand and is the hardest to clean. In a hand-washing study, the number of microbes under the nails was higher with longer nails, and washing with liquid soap plus a nailbrush removed the most, while alcohol gel alone removed the least.^[2] In studies of healthcare workers, artificial nails were more likely than natural nails to carry potentially harmful organisms, and the longer artificial nails had been worn, the more likely they were to.^[3] These studies weren’t about contact lenses, but your fingers touch every surface of the lens and its saline, so the same logic applies.

Holding your lids without your nails

• Pads, not tips. Lay the flat pad of your finger along the base of the lashes, with the nail angled away from the eye.
• Pull against the bone. Draw the upper lid up toward the brow and the lower lid down toward the cheek, so your fingers move away from the eye, not toward it.
• Use the hand that fits. Some people find it easier to hold both lids with one hand, others to use a finger from each hand. Try both with your fitter.

If your lids slip because your grip has to be lighter, see lids slip during insertion.

Inserting and removing

The tools are your friend here. The inserter holds the filled lens, so your fingers stay on the handle. For removal, a drop of artificial tears and the small plunger on the lower third of the lens does the work, with no need for a nail anywhere near the lens edge. See how to remove.

An insertion stand holds the lens steady on a counter, so you can use both hands for your lids, each with a flat finger pad.

After a manicure

Polish, cuticle oil, and hand cream can all end up on whatever you touch next. If you’ve just had your nails done, wait until polish is fully dry, wash your hands thoroughly with plain soap before handling your lenses, and inspect the lens against the light before it goes in.

Cleaning the lens

When you rub the lens with cleaner, lay it in the palm of one hand and rub with the flat pad of a finger, keeping the nail off the lens. If you find that hard, ask your fitter to watch you clean a lens at your next visit and suggest a grip.

Hand hygiene with long nails

The FDA advises washing your hands before handling contact lenses, to reduce the chance of infection.^[4] With long nails, that means:

1. Wash with plain soap. Moisturizing soaps leave a film on the lens.
2. Scrub under every nail with a clean nailbrush.
3. Rinse and dry completely with a lint-free towel.
4. Keep the nailbrush clean and dry, and replace it when it’s worn.

Never use water or saliva on the lens itself.^[4]

If it isn’t working

If your nails are making insertion take much longer, or you’ve poked or scratched your eye, tell your fitter. Be specific about which step is hard: holding your lids, loading the inserter, using the plunger, or cleaning. Each has a different fix. Keeping the nails on your lid-holding fingers shorter, using a stand, or adjusting your technique are all reasonable options, and your fitter can help you pick.