A fear worth taking seriously
You’re putting something on your eye every day, and you’ve probably heard a story about someone who lost vision to an infection. It makes sense to be afraid of that. The good news is that this is the one serious risk where your own habits make the biggest difference.
The FDA is direct about the stakes: wearing contact lenses puts you at risk of eye infections and corneal ulcers, which can develop very quickly, can be very serious, and in rare cases can cause blindness.[1] That’s true of all contact lenses, not just scleral lenses.
How often it happens
No study can give you your personal risk, but a few give a sense of scale:
- A keratoconus study. In 157 eyes that had worn scleral lenses successfully for at least a year at one clinic, microbial keratitis, an infection of the cornea, was recorded in 0.6% of eyes.[2] Because it included only people who were still wearing lenses, it doesn’t capture everyone.
- A large practitioner survey. Scleral lens fitters estimated that over one year, 0.45% of the 72,605 wearers they saw had to stop wearing scleral lenses because of microbial keratitis.[3] These are fitters’ estimates, not medical records, and they count only infections serious enough to stop lens wear.
So serious infections are uncommon in these studies. Uncommon isn’t never, which is why the habits and the warning signs below matter.
What raises the risk
Water
The FDA advises keeping contact lenses away from all water: tap, bottled, distilled, lake, and ocean. Tap and distilled water have been linked to Acanthamoeba keratitis, a corneal infection that’s resistant to treatment.[1] It also advises removing lenses before swimming, because of bacteria in pools, hot tubs, lakes, and the ocean.[1] Many wearers describe water as the habit they were most casual about until they heard what it can do. See swimming and showers.
Sleeping in your lenses
Across contact lenses in general, sleeping in lenses, whether by accident, occasionally, or on purpose, raises the risk of a lens-related eye infection six- to eightfold.[5] The FDA advises against sleeping in daily-wear lenses.[7] Scleral lenses come out before any sleep, including a nap. See can you sleep in scleral lenses?
Care shortcuts specific to scleral lenses
A report of three cases of Acanthamoeba keratitis in scleral lens wearers with keratoconus listed possible risk factors: reduced oxygen to the cornea, the large volume of saline used, storing lenses overnight in saline instead of a disinfecting solution, not rubbing lenses during cleaning, and the fluid reservoir behind the lens.[4] Three cases can’t tell you how common this is, but the risk factors line up with the habits wearers are most tempted to skip.
The habits that lower your risk
- Wash and dry your hands before you touch your lenses.[6]
- No water, ever, on your lenses, case, or plunger.[1]
- Fill with sterile saline, fresh each time, ideally from single-use vials, and never reuse it.[4]
- Rub and rinse your lenses as your fitter directs, and clean your plunger too.[4]
- Store lenses overnight in fresh disinfecting solution, not saline, and never top off old solution.[4][1]
- Let peroxide finish. For Clear Care, Alcon says to soak lenses at least 6 hours or overnight, and never to rinse lenses with it before insertion.[8]
- Replace your case every 3 months, or as your eye doctor directs.[1]
- Never sleep in your lenses.[7]
- Keep your follow-up visits, even when your eyes feel fine.
None of this is new if you’ve been trained, but tired nights and long trips are when corners get cut. The full routine is in cleaning and disinfecting and saline and solutions, and the shortcuts wearers most often take are in scleral lens habits to avoid.
The warning signs
The FDA lists these as symptoms of eye irritation or infection: discomfort, excess tearing or other discharge, unusual sensitivity to light, itching, burning or a gritty feeling, unusual redness, blurred vision, swelling, and pain.[1]
Some of these have everyday causes, like mild end-of-day grittiness. What matters is anything new, getting worse, or coming with pain or blurry vision that doesn’t clear when the lens is out. The FDA also says plainly that you can’t judge how serious a problem is yourself: an eye care professional has to look.[1]
If you think it’s starting
- Take the lens out and don’t put it back in.
- Keep the lens in its case. Your eye doctor may want to examine it.[1]
- Call your eye doctor today, including their after-hours line. If you can’t reach anyone, go to urgent care or an emergency room and tell them you wear scleral lenses.
- Wear your glasses until you’ve been seen.
Don’t wait overnight to see if it clears, and don’t treat it yourself with old drops. The full steps are in eye pain: when to get help.
If your stakes are higher
If you have only one seeing eye, a corneal transplant, or a condition or medicine that lowers your immune defenses, talk to your eye doctor specifically about infection risk and how fast you can be seen if something goes wrong. More on the research, including transplant eyes, is in are scleral lenses safe? For eye doctors, our complications overview covers infection alongside other findings.
What to ask your fitter
- Is anything about my eyes or my condition a reason for extra caution?
- Can you watch me do my cleaning routine and tell me if anything’s off?
- What’s your after-hours number, and what should I do if I can’t reach you?
- How often should I replace my case and my plunger?
Common questions
Are scleral lenses riskier for infection than soft lenses?
There isn't good research comparing them head to head. Scleral lenses have some features that matter, such as the reservoir of fluid against the cornea and the amount of saline involved, and soft lenses have their own risks. What's clear for every lens type is that care habits, water exposure, and sleeping in lenses make a big difference.
I got a splash of tap water on my lens. What should I do?
Don't wear it as it is. Clean and disinfect it fully with your usual products before it goes back in, and never rinse it with water to 'fix' it. If the lens was already in your eye and the eye becomes red, painful, or blurry, take the lens out and call your eye doctor.
I fell asleep in my lenses. Will I get an infection?
Not necessarily, but your risk went up. Take the lenses out as soon as you can, wear your glasses, and watch closely for pain, redness, light sensitivity, discharge, or blurry vision over the next day or two. If any of those appear, call your eye doctor that day and tell them you slept in your lenses.
Can I use antibiotic drops I have at home if I think it's starting?
Don't treat a suspected infection yourself. Old drops may be the wrong medicine, and some aren't meant to be used with a lens in. Take the lens out and call your eye doctor. They need to see the eye to decide on treatment.
I only have one good eye. Should I worry more?
The stakes are higher, so it's worth a specific conversation with your eye doctor about risk, backup plans, and how quickly you can be seen if something goes wrong. Having one seeing eye doesn't rule out scleral lenses, but it leaves less room for shortcuts. See our page on wearing scleral lenses with only one seeing eye.