Scleral Lenses for Dry Eye

Name: Scleral Lenses for Dry Eye
Creator: Dr. Edward Boshnick

Dry eye disease can cause burning, stinging, redness, foreign body sensation, fluctuating vision, light sensitivity, and contact lens intolerance. For selected patients with moderate to severe dry eye or ocular surface disease, scleral lenses may help protect the ocular surface during lens wear and improve visual function.

Dr. Edward Boshnick evaluates dry eye patients carefully before recommending scleral lenses. The goal is to understand the cause of the symptoms, the health of the tear film, the condition of the cornea, and whether a specialty lens should be part of a broader treatment plan.

How dry eye affects vision and comfort

Dry eye is not just a lack of tears. It can involve tear film instability, inflammation, meibomian gland dysfunction, ocular surface damage, autoimmune disease, medication effects, eyelid problems, or prior eye surgery. Because the tear film is part of the eye’s optical system, dry eye can also make vision blur or fluctuate throughout the day.

Some patients describe dryness and irritation. Others describe pain, burning, light sensitivity, eye fatigue, or the feeling that vision is never stable. A careful diagnosis matters because treatment depends on the cause.

How scleral lenses may help dry eye

A scleral lens is a custom gas-permeable lens that rests on the sclera, the white part of the eye, and vaults over the cornea. The space between the lens and the cornea is filled with preservative-free saline before insertion.

For selected dry eye patients, that design may help by:

Creating a fluid reservoir: the lens holds preservative-free saline over the cornea during wear.
Protecting the ocular surface: the lens may reduce exposure to air, wind, and friction from blinking.
Improving optical stability: a smoother front lens surface may reduce vision fluctuation from an unstable tear film.
Supporting contact lens tolerance: patients who cannot tolerate standard lenses may be candidates for a custom scleral design.

Scleral lenses do not treat the underlying causes of dry eye disease. They may help manage symptoms and visual function for some patients while the underlying dry eye causes are also addressed.

Dry eye conditions that may be evaluated for scleral lenses

Scleral lenses may be considered in complex dry eye and ocular surface conditions, including:

severe dry eye disease
ocular surface disease
Sjogren’s syndrome
graft-versus-host disease
Stevens-Johnson syndrome
neurotrophic keratitis
exposure keratopathy
post-LASIK dry eye
contact lens intolerance
corneal scarring or irregularity with dryness

Not every dry eye patient needs scleral lenses. Many patients need lid treatment, tear support, prescription drops, inflammation management, environmental changes, or other therapies. Dr. Boshnick’s evaluation helps determine where scleral lenses fit into the care plan.

Dr. Boshnick’s dry eye scleral lens evaluation

1. Symptoms and history

The evaluation begins with the patient’s history: symptoms, previous treatments, contact lens history, autoimmune disease, surgery history, medications, and daily visual demands.

2. Ocular surface and tear film assessment

Dry eye can involve the tear film, corneal surface, eyelids, and glands. Understanding these details helps determine whether the eye is ready for lens wear or needs additional treatment first.

3. Corneal shape and vision testing

Some dry eye patients also have irregular astigmatism, post-surgical corneal changes, keratoconus, or corneal scarring. Corneal imaging and vision testing help guide lens design.

4. Diagnostic scleral lens fitting

Diagnostic fitting helps evaluate lens vault, landing, tear reservoir, comfort, vision, and how the eye responds during wear. The final lens may require refinements and follow-up visits.

Scleral lenses vs. standard dry eye treatments

Scleral lenses are usually not the first step for mild dry eye. They are most often considered when symptoms are more complex, when the ocular surface needs protection, or when vision and comfort remain poor despite other care.

Approach	Role in dry eye care
Artificial tears	May help mild symptoms; preservative-free drops are often preferred for frequent use.
Lid and gland treatment	May help when meibomian gland dysfunction contributes to tear film instability.
Prescription anti-inflammatory drops	May be used when inflammation is part of the dry eye process.
Punctal plugs or tear conservation	May be considered for selected patients depending on tear production and inflammation.
Scleral lenses	May protect the ocular surface and create a fluid reservoir during wear for selected moderate to severe cases.
Systemic or autoimmune care	May be needed when dry eye is related to Sjogren’s syndrome, graft-versus-host disease, or another medical condition.

What patients should expect

Scleral lens success depends on the condition of the eye, lens design, handling, hygiene, wearing schedule, and follow-up care. Some patients need time to learn insertion and removal. Some need adjustments to improve comfort, reduce fogging, or refine vision.

Patients with severe ocular surface disease may also need ongoing dry eye therapy while wearing scleral lenses. The lens can be an important tool, but it is not a replacement for diagnosing and managing the underlying disease.

Frequently asked questions

Can scleral lenses help dry eye?

They may help selected patients with moderate to severe dry eye or ocular surface disease by creating a fluid reservoir over the cornea and protecting the ocular surface during wear.

Do scleral lenses eliminate dry eye?

No. Scleral lenses do not eliminate dry eye disease. They may help manage symptoms, comfort, and vision for selected patients as part of a broader treatment plan.

Can scleral lenses help Sjogren’s syndrome dry eye?

Some Sjogren’s syndrome patients are evaluated for scleral lenses because the ocular surface can become severely dry and sensitive. Candidacy depends on the eye examination, ocular surface health, and the patient’s ability to handle and care for the lenses.

Why do scleral lenses fog with dry eye?

Midday fogging can happen when debris, inflammation, tear film changes, or lens fit issues affect the fluid reservoir. Follow-up visits are important because the solution may involve lens design changes, ocular surface treatment, or changes in filling solution and care routine.

Are scleral lenses safe for dry eye?

Scleral lenses are medical devices and should be fit and monitored by an experienced professional. Proper cleaning, disinfection, insertion, removal, and follow-up care are essential.

Related Eye Freedom resources

Medical sources

This page is educational and is not a diagnosis or treatment plan. A specialty examination is needed to determine whether scleral lenses are appropriate for your dry eye or ocular surface condition.