Scleral lenses are large-diameter contact lenses designed to rest on the sclera, vaulting completely over the cornea. This design creates a fluid-filled reservoir, which is beneficial for managing conditions like severe dry eye or keratoconus. Standard practice involves using a small suction tool, often called a plunger, for removal because of the strong seal these large lenses create. When this specialized tool is unavailable, a safe, alternative technique for manual removal is necessary. A careful, precise finger technique can be employed to safely remove the lens without causing ocular damage.
Preparing for Manual Removal
Strict hygiene protocols must be followed any time fingers are brought near the eye to prevent infection. Begin by washing your hands thoroughly with a non-moisturizing, non-scented soap, scrubbing for at least 20 seconds. Rinse all soap residue completely, then dry your hands using a clean, lint-free towel or a paper towel.
Preparing the environment is equally important to ensure visibility and prevent the lens from being lost or damaged. Perform the removal over a clean, flat surface, such as a table covered with a soft, clean towel, to cushion the lens if it drops. Work in front of a well-lit mirror, which provides the necessary visualization to confirm proper finger placement and lens movement.
Before attempting physical removal, lubricate the eye and the lens interface to loosen the suction seal. Apply several drops of a preservative-free saline solution, the same fluid used for insertion, directly onto the lens surface. This fluid can migrate under the lens’s edge and help gently break the vacuum seal. Blink a few times after applying the drops to allow the saline to distribute evenly beneath the lens.
Step-by-Step Finger Technique
The goal of manual scleral lens removal is to break the peripheral suction seal so the lens can slide out easily, not to pull it off the eye. The most effective technique involves using the eyelid margin as a wedge to gently lift the lens edge. Start by looking straight ahead into the mirror and stabilizing your upper eyelid firmly at the lash line with the index finger of your non-dominant hand. Hold the lid taut to prevent it from interfering with the removal process.
Next, position the index finger of your dominant hand on the lower eyelid, right along the lash line. Gently press your lower lid inward and upward, aiming the edge of the eyelid underneath the bottom edge of the scleral lens. This pressure is intended to create a pivot point and introduce a small air bubble underneath the lens. Once the seal is broken, the lens will feel loose, and you may see a small air pocket appear beneath the lower edge.
Two-Finger Pinch Variation
A variation uses two fingers directly on the lens edge, typically the index finger and thumb, instead of the eyelid. Stabilize the eye by holding the upper lid. Use the thumb and index finger of your dominant hand to apply gentle pressure to the lens edges at the 5 and 7 o’clock positions. Direct the pressure slightly inward toward the center of the lens, then simultaneously outward and away from the eye in a controlled pinching motion. Apply pressure only to the very edge of the lens, avoiding the center, to allow the lens to flex and release the suction.
Once the seal is broken by either the eyelid or the two-finger method, the lens should easily slide off the eye without resistance. Angle your chin slightly downward while looking up to help gravity assist the lens in falling onto the cushioned surface. If the lens does not release easily, re-lubricate the eye with more saline drops before trying again. Never use fingernails during this process; only the soft pads of the fingers should make contact with the eye or lens.
When to Stop and Seek Professional Help
Manual removal can be challenging, and it is important to recognize when to stop attempting the process to prevent injury. If the lens feels firmly stuck after several attempts, or if you experience significant pain, a scratchy sensation, or increased redness, immediately cease the removal attempts. Repeated, aggressive manipulation can lead to a corneal abrasion, which is a scrape on the outer layer of the cornea that is painful and prone to infection.
If the lens remains firmly adhered, increase lubrication by applying a generous amount of preservative-free artificial tears or saline solution and waiting a few minutes. Take a break to allow your eye to rest, as tension often makes the process more difficult. If you have tried the steps multiple times without success, or if your eye is noticeably red, swollen, or producing excessive tearing, contact your eye care professional (ECP).
Your ECP has specialized tools and training to safely remove a stuck lens in the office, minimizing the risk of permanent damage. If the pain is severe or the eye is visibly damaged outside of regular business hours, seek emergency eye care immediately. Protecting the health of your cornea is the top priority, and forcing removal in a high-stress situation increases the risk of complications.