Contact lenses are primarily used for vision correction or for cosmetic reasons. However, many patients with chronic medical conditions that affect their eye health may benefit from specialty custom contact lenses for therapeutic use.
What are scleral lenses?
Scleral lenses are large-diameter, gas-permeable contact lenses that differ from conventional lenses in that they land on the sclera of the eye without touching the cornea at any point. This area between the cornea and the scleral contact lens is known as the "vault." The vault is filled with a reservoir of preservative-free saline solution, or sometimes with preservative-free lubricant eye drops. This creates a bowl of tears to constantly bathe the cornea and promote healing of the eye surface. This also creates a shield for a sensitive or compromised cornea from the outside environment or from the shear forces of blinking.
Conditions that benefit from scleral lenses include:
Inflammatory autoimmune diseases (Sjogren's syndrome, rheumatoid arthritis, lupus, dry eye syndrome)
With many autoimmune inflammatory conditions, decreased tear production and inflammation of the ocular surface results from the dry surface, which leads to a cycle of more inflammation and dryness. A scleral lens can be used to replace a patient’s own ocular surface with essentially a prosthetic ocular surface. This helps decrease the constant need for artificial tears and promotes healing of the surface.
Bell's palsy or other incomplete eyelid closure abnormalities (exposure keratitis)
Patients with eyelid abnormalities may want to schedule a scleral lens consultation before considering eyelid surgery. In many cases, scleral lenses may eliminate the need for surgery by keeping the eyes bathed in tears, and eliminating the patient’s inability to blink.
Herpes simplex, congenital defects, or other post-surgical trauma or post-viral infections
These conditions result in impaired tear production. This commonly leads to non-healing eye tissue defects and corneal scarring. A scleral lens on the eye allows time for cells in the outermost layer of the cornea to regenerate and heal while also creating an artificial tear film for the patient.
Other severe conditions that benefit from the therapeutic use of scleral lenses include graft-versus-host disease, cicatricial pemphigoid, and toxic epidermal necrolysis.
Scleral lenses offer a conservative, non-surgical approach for many patients with chronic conditions that would prefer self-management techniques rather than surgery or medications.