If you’ve lived with severe dry eye for a while, you’ve probably heard “this might help” many times. It’s reasonable to protect yourself from another disappointment. So here is what the evidence actually says, including the parts that aren’t encouraging.
What scleral lenses do for dry eye
A scleral lens rests on the white of the eye and vaults over the cornea. Before it goes in, the bowl is filled with sterile saline, so the cornea sits under a reservoir of fluid all day instead of drying out between blinks. For a cornea that has been raw and exposed, that can be a big change.
What it doesn’t do is make your eyes produce more or better tears, treat inflamed eyelids, or reach the parts of the eye outside the lens. That’s why it rarely works alone.
What the studies show
The evidence is encouraging but limited. Most of it comes from single clinics, with small groups and no comparison group, and often mixes several diseases together.
- People who had already tried a lot. At one US referral center, 212 people with ocular surface disease were evaluated for scleral lenses. They had tried an average of 3.2 other treatments first. Of the 115 who completed the fitting process, all but 2 reached the treatment goals, such as better comfort or a healed surface. Vision improved too.[1]
- Symptoms and quality of life. In a Brazilian study of 25 people with moderate to severe dry eye, including Stevens-Johnson syndrome, Sjögren’s, and graft-versus-host disease, dry eye symptom scores and quality-of-life scores both improved significantly after 12 months of wear.[2]
- Fewer medicines, in the short term. In a study of 15 people with severe dry eye followed for one month, symptom scores dropped, and the average number of medicine types per eye fell from 2.82 to 1.32.[3]
The sobering parts matter just as much:
- Not everyone finishes the fitting. In the US center above, 115 of 212 people evaluated completed the fitting process.[1] The rest didn’t, for reasons the study summary doesn’t spell out.
- Many wearers still struggle. In a survey of people with dry eye, 75% of those wearing scleral lenses reported midday fogging or clouding of vision, and 72% spent more than 20 minutes a day on dry eye care. As a group, their symptom scores were still in the severe range. The survey looked at one point in time, so it can’t show how they felt before lenses.[5]
- Dry eye without other corneal problems has the thinnest evidence. A 2024 review called the evidence for that group sparse, and listed midday fogging, poor lens wetting, and mixed satisfaction among the challenges.[4]
It also helps to know that dry eye is a less common reason for scleral lenses overall. In an international survey of fitters, 9% of patients were wearing them for ocular surface disease, compared with 87% for an irregular cornea.[6] Ask any fitter you’re considering how many people with your condition they see.
The deeper research summary is in scleral lenses for dry eye: the research.
What “helping” usually looks like
For many wearers, success isn’t “my dry eye is gone.” It’s being able to drive again, read for an hour, work at a screen, or go outside without pain. Wearers who describe scleral lenses as life-changing for dry eye often say in the same breath that they’re a tool, not a cure, and that they still use drops, lid treatments, or moisture chamber glasses.
Relief also isn’t always instant or linear. The first lens may not be the final one, and fit, fill solution, and surface coatings often need adjusting. See how fast do scleral lenses relieve dry eye? and can your eyes be too dry for scleral lenses?
What’s usually combined with them
Severe dry eye is usually managed with several treatments at once, and scleral lenses are added to the plan rather than replacing it. Depending on the cause, that can include:
- Treating the eyelids and oil glands, since lid disease can cause fogging and smearing on the lens
- Prescription anti-inflammatory drops, used as your doctor directs around lens wear
- Autologous serum drops: see scleral lenses vs serum drops
- Punctal plugs: see scleral lenses vs punctal plugs
- Moisture chamber glasses for wind, fans, and screens
- Treating the underlying disease, such as Sjögren’s or ocular graft-versus-host disease, with the specialists involved
For day-to-day comfort while wearing, see dry eyes while wearing sclerals and midday fogging. For dry eye treatment in general, see our sister site 1-800-dry-eyes.com.
If they really don’t help
Some people find scleral lenses don’t give enough relief, or the burden of the routine outweighs the benefit. That isn’t a personal failure, and it doesn’t mean you’ve run out of options. Before you stop, it’s worth asking whether the lens design has been changed, whether lid disease or nerve-related pain has been looked at, and whether a second opinion from a fitter who sees a lot of dry eye makes sense. See severe dry eye for the wider range of treatments, and what if scleral lenses don’t work for me.
Questions to ask before you start
- How many patients with my kind of dry eye do you fit?
- What results do you think are realistic for me?
- What else in my treatment plan should continue alongside the lenses?
- How many visits and lens changes does the fee include?
- If the lenses don’t give enough relief, what would you suggest next?
Common questions
How quickly will I know if scleral lenses are helping my dry eye?
Many people feel some relief as soon as the lens goes in, because the cornea is suddenly bathed in fluid. Full comfort usually takes longer, while the fit, the fill solution, and your other treatments are fine-tuned. Give it time before you decide, and tell your fitter how each lens feels after several hours, not just at the visit.
Will I be able to stop my other dry eye treatments?
Some people cut back, but few stop everything. In one small study, the number of medicine types per eye roughly halved after a month of scleral lens wear. Change or stop prescribed treatment only with the doctor who prescribed it.
Why does the white of my eye or my eyelids still feel dry with the lens in?
The lens covers the cornea and part of the white of the eye, but not your lids or the white outside the lens edge. Those areas can still feel dry and may need their own treatment. Your fitter may also consider whether a different lens size would help.
What if my dry eye pain is actually nerve pain?
Some people have eye pain that comes from the nerves rather than the surface. A scleral lens may help some of them, but not all. If your pain seems out of proportion to what your doctor sees on the eye, ask whether neuropathic pain has been considered.
I've failed rigid lenses before because of dryness. Will sclerals be different?
They might. Smaller rigid lenses sit on the cornea, while a scleral lens rests on the white of the eye with a reservoir of fluid over the cornea. Many wearers who couldn't tolerate smaller rigid lenses describe scleral lenses as far more comfortable, but there's no guarantee for any one person.