Scleral Lenses for Sjogren’s Syndrome and Severe Ocular Surface Disease

Sjogren’s syndrome and severe ocular surface disease can make the eyes feel painfully dry, sensitive, gritty, and unstable. Vision may fluctuate because the tear film and corneal surface are not healthy enough to provide a clear optical surface. For selected patients, scleral lenses may help protect the ocular surface during wear and improve functional vision.

Dr. Edward Boshnick evaluates complex dry eye and ocular surface disease with attention to the tear film, cornea, eyelids, inflammation, previous treatments, and the patient’s ability to safely handle specialty lenses. Scleral lenses are not a replacement for medical dry eye care, but they may be an important part of a broader care plan.

Why Sjogren’s dry eye can be difficult

Sjogren’s syndrome can reduce tear production and contribute to ocular surface inflammation. Patients may experience burning, foreign body sensation, redness, light sensitivity, blurred vision, mucus, eye fatigue, and difficulty tolerating contact lenses or windy environments.

Severe ocular surface disease can also occur with graft-versus-host disease, Stevens-Johnson syndrome, neurotrophic keratitis, exposure keratopathy, autoimmune disease, prior surgery, or chronic inflammation. These conditions require careful diagnosis and ongoing medical supervision.

How scleral lenses may help

Scleral lenses are custom gas-permeable lenses that rest on the sclera and vault over the cornea. Before insertion, the bowl of the lens is filled with preservative-free saline, creating a fluid reservoir over the front surface of the eye during lens wear.

• Ocular surface protection: the lens may shield the cornea from air exposure and friction during blinking.
• Fluid reservoir: preservative-free saline beneath the lens may support comfort during wear.
• Visual stability: the lens may create a smoother optical surface when dryness causes fluctuating vision.
• Contact lens tolerance: patients who cannot tolerate standard lenses may be candidates for a custom scleral design.

Scleral lenses do not eliminate Sjogren’s syndrome or ocular surface disease. They may help manage symptoms and visual function for selected patients while the underlying condition is also treated.

Conditions in this cluster

• Sjogren’s syndrome dry eye
• severe dry eye disease
• ocular surface disease
• graft-versus-host disease affecting the eyes
• Stevens-Johnson syndrome / toxic epidermal necrolysis eye complications
• neurotrophic keratitis and severe ocular surface disease
• exposure keratopathy
• persistent epithelial problems
• contact lens intolerance caused by ocular surface disease

Dr. Boshnick’s evaluation process

1. Symptom and medical history

The evaluation includes dry eye symptoms, systemic diagnoses, medications, previous treatments, contact lens history, pain or light sensitivity, and daily visual demands.

2. Tear film and ocular surface assessment

The cornea, conjunctiva, eyelids, tear film, and ocular surface staining pattern are evaluated because these findings influence lens safety, comfort, and wearing time.

3. Diagnostic scleral lens fitting

Diagnostic fitting helps evaluate comfort, vault, landing, fluid reservoir, vision, and how the ocular surface responds. Severe ocular surface disease may require conservative wearing schedules and close follow-up.

4. Broader care planning

Some patients also need prescription dry eye therapy, lid treatment, serum tears, punctal occlusion, systemic care, or co-management with a corneal specialist, rheumatologist, oncologist, or other physician.

What patients should expect

The fitting process may take multiple visits. Patients need training in insertion, removal, cleaning, disinfection, filling solution, wearing time, and warning signs that require prompt attention. Follow-up visits are important because dry eye and ocular surface disease can change over time.

Some patients experience improved comfort and more stable vision during wear. Others may need additional ocular surface treatment before lens wear is successful. Dense scarring, active inflammation, infection risk, poor handling ability, or severe epithelial fragility may limit candidacy.

Frequently asked questions

Can scleral lenses help Sjogren’s dry eye?

They may help selected Sjogren’s patients by protecting the ocular surface during wear and maintaining a fluid reservoir over the cornea. A specialty evaluation is needed to determine candidacy.

Do scleral lenses eliminate Sjogren’s syndrome?

No. Scleral lenses do not eliminate Sjogren’s syndrome or the underlying autoimmune process. They may help manage eye comfort and visual function as part of a broader care plan.

Can scleral lenses help graft-versus-host disease or Stevens-Johnson syndrome?

Some patients with severe ocular surface disease from these conditions are evaluated for scleral lenses or prosthetic scleral devices. These cases require careful medical supervision and individualized fitting.

Why do scleral lenses fog in severe dry eye?

Fogging can be related to inflammation, tear debris, lens fit, solution issues, or ocular surface disease. Follow-up care helps determine whether the lens design, filling solution, or medical treatment plan should be adjusted.

Related Eye Freedom resources

• Scleral lenses for dry eye
• Dry eye syndrome
• Corneal disease
• Scleral lens FAQ
• Scleral lenses
• Request an evaluation

Medical sources

• Sjogren’s Foundation: Dry Eye
• American Academy of Ophthalmology: Sjogren Syndrome Dry Eye
• Peer-reviewed review: Therapeutic Uses of Scleral Contact Lenses for Ocular Surface Disease
• PubMed: Scleral Lens Fitting in Refractory Ocular Surface Disease

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 Sjogren’s syndrome or severe ocular surface disease.