Scleral lenses are specialized, large-diameter contact lenses designed to vault completely over the cornea and rest entirely on the sclera (the white part of the eye). This design creates a fluid-filled reservoir between the back surface of the lens and the corneal tissue, benefiting individuals with irregular corneas, such as those caused by keratoconus, or severe dry eye disease. While a suction tool, or plunger, is the standard removal method, alternative manual techniques are necessary when the tool is unavailable or ineffective. Learning these finger-based methods helps protect eye health during an emergency or when traveling without the proper equipment.
Understanding Scleral Lens Adherence
The difficulty in removing a scleral lens without the standard plunger stems from its unique mechanism of adhesion. Scleral lenses are held in place by two physical forces, the most significant being surface tension. The large diameter of the lens and the fluid layer underneath create a liquid interface between the lens edge (haptic) and the ocular surface, causing the lens to stick. A secondary factor is sub-atmospheric pressure, or suction, which can develop if the fluid layer is lost or the lens settles tightly onto the conjunctiva. The goal of any manual removal technique is to intentionally break this vacuum seal by introducing air or fluid beneath the edge of the lens.
Essential Preparation and Safety Protocols
Before attempting any manual removal, proper hygiene and preparation are essential. Thoroughly wash your hands with a non-moisturizing soap, rinse completely, and dry them with a clean, lint-free towel. Residue from scented or oily soaps can transfer to the lens surface, causing irritation or damage.
Set up your work area in a well-lit space, sitting at a stable surface with a clean, soft towel placed nearby. The towel serves as a clean landing surface if the lens pops out unexpectedly, preventing damage or loss. Adequate lighting is necessary to clearly visualize the lens edge and finger placement during removal.
Lubrication of the eye helps prevent corneal damage during removal attempts. Instill a few drops of preservative-free saline or rewetting drops into the eye before starting to loosen the lens and ensure the surface is moist. This step helps break the surface tension and prevents scratching if the lens is dry or stuck.
Manual Removal Techniques
The most effective non-plunger method uses your eyelids and fingers to break the vacuum seal, often called the “Lid Margin” technique. This involves manipulating the lid margin (the edge of the eyelid near the lashes) to apply pressure directly under the lens edge and introduce air. This requires anchoring the eyelids to open them wider than the lens diameter.
Start by stabilizing the upper eyelid: gently place the index finger of one hand at the lash line and pull it up and away from the eye. Use the index finger or thumb of your other hand to pull the lower lid down and anchor it firmly against the lower orbital bone. With both eyelids secured and the eye wide open, the lens edge should be fully exposed.
To initiate the seal break, look straight ahead. Bring the index finger of the hand holding the lower lid up to the very edge of the lower eyelid. Press gently but firmly inward and slightly upward, aiming to tuck the edge of the lower lid under the bottom edge of the lens. This action should cause a small bubble of air to enter the space beneath the lens.
Lateral Slide Technique
Alternatively, the “Lateral Slide” technique uses horizontal movement to shear the lens off the eye. After anchoring the lids, use the pad of your index finger to gently apply pressure to the bottom edge of the lens. Instead of pushing up, slide the lens horizontally towards the outer corner of your eye, keeping the pressure light and steady. Sliding the lens off the central cornea toward the sclera and conjunctiva allows the pressure differential to release the seal.
These lenses are designed to fit the curvature of the eye, so they naturally resist being moved off-center. Avoid applying direct pressure to the center of the lens, as this increases suction and makes removal more difficult. Movement must focus on the lens periphery to disrupt the haptic seal without causing excessive force on the central cornea.
Troubleshooting and When to Seek Help
It is common to encounter resistance, especially if the lens fit is tight or the eye is dry. If the lens remains strongly adhered after gentle attempts, resist the urge to increase force, which could damage the eye or the lens. Instead, pause and re-lubricate the eye with several drops of preservative-free saline or artificial tears, allowing a minute or two for the fluid to work its way under the lens.
If the lens still resists removal, try using a sterile Q-tip or a piece of sterile gauze to assist in breaking the seal. Gently moisten the cotton tip and use it to apply targeted pressure at the edge of the lens, similar to the finger technique, to nudge air underneath. The soft material of the Q-tip or gauze may provide a better grip or finer point of leverage than a fingertip.
A well-fitting scleral lens should remove without significant resistance. If the eye becomes noticeably red, painful, or irritated after multiple gentle removal attempts, stop. Excessive force or prolonged attempts increase the risk of corneal abrasion or conjunctival damage. If the lens remains stuck, contact your eye care professional for assistance or seek emergency care, as they possess specialized tools and expertise to safely remove the lens.