Scleral lenses are specialized, large-diameter contact lenses designed to manage complex eye conditions. Unlike standard lenses that sit on the sensitive cornea, these rigid, gas-permeable lenses vault entirely over the corneal surface and rest on the less-sensitive sclera, the white part of the eye. This design creates a fluid-filled reservoir between the lens and the cornea, which benefits patients with irregular corneal shapes, such as those caused by keratoconus, or severe dry eye disease. Due to their size and the necessity of maintaining this fluid reservoir, the process of putting in and removing scleral lenses requires a practiced, systematic technique.
Essential Preparation Before Handling
Before touching the lenses, meticulous hand hygiene is necessary to prevent introducing pathogens or debris to the eye. Hands should be washed thoroughly with a mild, non-moisturizing soap, as residue from lotions or perfumes can contaminate the lens surface and cause irritation. After washing, hands must be dried completely with a lint-free towel to ensure no fibers adhere to the lens or the specialized insertion tools.
The scleral lens must be prepared immediately before insertion by filling its bowl with an approved, preservative-free saline solution. This step is critical because the saline creates the fluid vault between the lens and the cornea, acting as a liquid bandage and hydration source. The lens must be filled completely to the brim to prevent air bubbles, which cause discomfort and compromise vision if they rest over the visual axis. The lens is typically placed onto a specialized insertion tool, such as a large suction plunger or a tripod stand, for stability during filling.
Detailed Steps for Scleral Lens Insertion
The insertion process begins by securing the lens onto the insertion device, ensuring the saline solution remains in the bowl. Users often lean forward so their face is parallel to the floor, minimizing the chance of the fluid spilling prematurely. This position also allows gravity to assist in stabilizing the lens during the approach to the eye.
Stabilizing the eyelids is necessary to create an opening wider than the lens diameter. The non-dominant hand holds the upper eyelid against the brow bone and the lower eyelid against the cheekbone, preventing any blinking reflex. Keeping the eyelids fully retracted is necessary to avoid the lens touching the lashes or the lid margins, which would cause the saline to spill or the lens to get misaligned.
With the eye fully open and the head positioned looking straight down, the insertion tool is brought slowly and deliberately toward the eye. The user should focus on a fixation point, such as a small light or a mark on a mirrored surface placed below them, to keep the eye centered and steady. The lens should be aligned directly over the center of the cornea and gently pressed into place until the fluid reservoir makes full contact with the eye. Once the lens is fully docked, the insertion tool is released, and the eyelids can be carefully let go, allowing the lens to settle onto the sclera.
Safe and Effective Lens Removal
Removing a scleral lens requires a different technique and a smaller, specialized removal plunger. The plunger’s tip should be slightly moistened to assist with adhesion to the lens surface. Removal depends on creating a strong suction seal to lift the lens away from the eye.
The removal plunger is generally applied to the lower outer edge of the lens, rather than the center. This off-center placement allows the plunger to lift the lens edge slightly, effectively breaking the suction seal holding the lens onto the eye. Once the plunger is firmly attached to the lens edge, the lens is gently pulled away from the eye in a downward and outward motion.
The eyelids must be held open during this process, similar to insertion, to ensure the lens does not contact the lid margin as it is being removed. If the lens does not release easily, a slight twisting or rocking motion of the plunger can help to break the capillary forces holding the lens in place. Immediately following removal, the lens should be cleaned and disinfected in its storage case according to instructions.
Troubleshooting Common Insertion Issues
The most common problem during insertion is trapping an air bubble beneath the lens surface. An air bubble usually signals insufficient saline volume or contact between the lens and the eyelid, causing the saline to spill. Even a small bubble causes immediate discomfort, blurry vision, and can lead to localized drying of the cornea.
If a bubble is noticed immediately after insertion, the lens must be removed, thoroughly rinsed, refilled with fresh preservative-free saline, and reinserted. Difficulty maintaining a wide-enough opening of the eyelids is another common issue, which can be overcome by practicing stabilization and pinning the lids firmly at the lash line. Immediate irritation can also be caused by debris or a foreign particle not adequately rinsed from the lens before filling. Visually inspecting the lens against a light source and ensuring the saline is filled completely to the top edge can prevent most insertion-related issues.