What if something goes wrong at night or on a weekend?

Why this one keeps people up at night

Many scleral lens wearers depend on their lenses and on one specialist practice, sometimes hours away. So the thought of a problem at 10 p.m. on a Saturday is a real worry. Wearers often say the scariest part isn’t the problem itself, it’s not knowing whether it’s an emergency.

The good news: most lens problems aren’t emergencies, and the few that are have a clear first step. A little setup now makes a bad night much easier.

Step one, almost always: take the lens out

For nearly any problem, the first move is the same. Remove the lens the usual way: a drop of artificial tears, then the removal plunger on the lower third of the lens, never the center. Then put it in its case with fresh solution and switch to your glasses.

If you have symptoms of eye irritation or infection, the FDA’s advice is to remove your lenses right away, not put them back in, contact your eye care professional, and keep the lenses in their case, because your eye doctor may want to examine them.^[1]

If the lens won’t come out, don’t force it. Rest, add more drops, and try again with the plunger lower on the lens. A lens can’t get lost behind your eye: the membrane that lines your eyelids folds back over the white of the eye, so there’s nowhere for it to go.^[3] Step by step: stuck lens.

Can it wait, or not?

Get help today, even after hours

• Eye pain, especially sudden or severe.
• Redness that’s getting worse.
• New sensitivity to light.
• Discharge, especially yellow or green, or a lot of tearing.
• Blurry vision that doesn’t clear once the lens is out.
• Swelling of the eye or eyelid.
• A lens you can’t remove after a few gentle tries and a rest. Don’t sleep in it.^[2]
• A lens that broke while it was in your eye and your eye hurts, or you think a piece is still there.
• Sudden new floaters, flashes of light, or a shadow or “curtain” over part of your vision. These are signs of a retinal detachment, which the National Eye Institute calls a medical emergency: go to your eye doctor or an emergency room right away.^[4] They’re usually not lens problems, so don’t spend time troubleshooting the lens. See new flashes or floaters.

The FDA lists discomfort, discharge, light sensitivity, itching or burning, unusual redness, blurred vision, swelling, and pain as symptoms of eye irritation or infection, and notes that these can develop very quickly. It also says you can’t judge how serious a problem is yourself.^[1] If in doubt, treat it as urgent.

Usually fine until the office opens

These can usually wait, as long as the lens is out, you’re wearing your glasses, and your eye feels and looks normal:

• A chipped, cracked, or lost lens.
• A dropped lens you can’t clean and disinfect properly tonight.
• Fogging, haze, or a lens that’s become uncomfortable.
• Running low on saline or solution. Wear your glasses rather than improvising: no tap water, homemade saline, or untested products.

If any warning sign appears while you wait, it moves to the “today” list.

Who to call, in order

1. Your fitter’s after-hours line. Many practices have an answering service or an on-call doctor. Say you wear scleral lenses, which eye, what you feel, and when it started.
2. Another eye care practice, or an on-call optometrist or ophthalmologist if your area has one.
3. Urgent care or an emergency room if you have warning signs and can’t reach eye care. Not every urgent care or emergency room has eye equipment or an eye specialist on hand, so if you can, call ahead and ask, or ask whether there’s an eye emergency service nearby.

Tell staff straight away that you wear scleral lenses. Bring your lens case, your solutions, your glasses, and your removal plunger. Mention anything unusual: a nap in your lenses, water exposure, a new product, or a dropped lens you put back in. More detail in eye pain: when to get help.

If the staff have never seen a scleral lens

This happens. Many emergency and urgent care staff have never removed one, and the usual soft-lens tricks don’t work. Two things help:

• Carry the printable emergency card. It tells staff what you wear, who fits your lenses, how to reach them after hours, and how to remove a scleral lens.
• Point staff to our removal guide for emergency and urgent care staff. It covers lubrication, plunger placement, what not to do, and when to stop and call eye care.

If you’re able, offer to remove the lens yourself or talk staff through it. Many wearers also keep a note in their phone’s medical ID saying they wear scleral lenses and where their plunger is, in case they can’t speak for themselves.

The peroxide trap

If you disinfect with hydrogen peroxide, your lenses may be mid-cycle when trouble starts. Don’t cut the cycle short. For Clear Care, Alcon says to soak lenses at least 6 hours, and that inserting them early can cause burning and stinging.^[5] Wear your glasses. Some wearers keep a second pair of lenses partly so one is always ready.

Set this up now, while nothing’s wrong

• Ask your fitter for their after-hours plan. Who answers? Is there an on-call doctor? Where should you go if they can’t be reached, especially when you’re traveling?
• Save that number in your phone, and write it on your emergency card.
• Keep current glasses where you can reach them at night. The FDA recommends always having a backup pair with a current prescription.^[2]
• Keep a spare plunger and artificial tears by your bed and in your bag. See your emergency kit.
• Know your nearest options: an eye emergency service, and which local urgent care or emergency room has eye care available.
• Tell someone you live with how a scleral lens comes out.

What to ask your fitter

• What’s your after-hours number, and who answers it?
• Which problems do you want to hear about at night, and which can wait for morning?
• If I can’t reach you, where should I go?
• Would a backup pair of lenses make sense for me?