Scleral lens care: cleaning, disinfecting and filling

Care systems differ, and some products must be used in a specific way to be safe. Follow the instructions your fitter gives you and the label of each product exactly. This page explains the general principles so the routine makes sense; it is not a regimen.

Care products are designed for specific jobs, and mixing them up can cause problems. Cleaning loosens and removes deposits from the lens surface. Disinfecting reduces microorganisms. Filling places a sterile fluid in the lens bowl before it goes on the eye. A product made for one job usually cannot do another safely, even if the bottles look similar.

Saline, for example, does not disinfect. Its role in scleral lens care is usually filling or rinsing as your fitter directs, and the fitter will normally specify a sterile, preservative-free saline for filling. Some lenses have special coatings or materials that only work with certain products. That is why your fitter's written routine, not a general list, is the guide to follow.

Wash your hands with soap and water, then dry them fully with a clean, lint-free towel. Wet hands can transfer tap water to the lens. Keep lenses, cases and tools away from all water, including taps, showers and swimming, and take lenses out before showering or swimming.

Use fresh solution every time. Do not top off old solution in the case. Do not sleep in lenses unless your eye care provider tells you to.

Handwashing is about what your fingers bring to the lens. Wash with soap, rinse, then dry thoroughly with a clean, lint-free towel. Wet hands carry water, and tap water should not touch the lens or case. Long or sharp nails can scratch a lens or the eye, so many fitters suggest keeping them short and smooth.

Lenses need cleaning and disinfecting after each wear to remove deposits and kill microbes. Your fitter will prescribe a specific system.

If your system uses hydrogen peroxide, it must be fully neutralized before a lens touches your eye. The FDA explains that peroxide systems neutralize either in a special case with a built-in disc or with a separate step. Use the new case supplied with each new bottle, and leave lenses for the full time on the label. Never put peroxide directly in your eye, and never use it to fill or rinse a lens right before insertion.

Saline is useful for rinsing when your fitter approves it, but it does not disinfect.

Some lenses have surface treatments or coatings that need compatible products. If your lens has a coating, ask which cleaners and storage solutions are safe for it.

Hydrogen peroxide systems disinfect well, but the peroxide itself would injure the eye. The system is designed so that its supplied case, disc or tablet neutralizes the peroxide into water and oxygen. Only after the full neutralization time on the product label is the lens safe to handle for insertion. Using the wrong case, or taking the lens out early, can leave active peroxide on it.

Think of the neutralization step as a gate that must close before the lens moves on. Never put peroxide directly into your eye, never use it to fill the lens bowl, and never rinse a lens with peroxide before insertion. The FDA also advises using the new case that comes with each new bottle, because an old case may not neutralize fully. Many peroxide bottles have a red tip or cap as a reminder. The figure below shows that one-way path.

Systems differ in how neutralization happens. Some neutralize inside the special case during disinfection, in one step; others use a separate neutralizing tablet added afterward, in two steps. Use only the case or neutralizer supplied for your product and follow its exact instructions, so neutralization finishes completely before the lens is handled.

If unneutralized peroxide gets into an eye, treat it as an emergency. Remove the lens and rinse the eye right away with plenty of room-temperature running water for at least 15 to 20 minutes, then call Poison Control (1-800-222-1222 in the U.S.) or use its online tool. Get urgent eye care if pain, redness or vision problems are severe or do not settle. Rinsing an injured eye is first aid; the rule against water on lenses applies only to routine lens care.

The bowl of a scleral lens is filled before insertion. This fluid sits against your cornea all day, so it must be sterile and preservative-free. Use only the filling solution your fitter recommends, and discard single-use vials after one use.

Never use tap water, even for rinsing. Tap water can carry organisms, including Acanthamoeba, that cause serious eye infections.

Fill the lens with fresh solution each time, from a container your fitter approved. Do not top off old solution or reuse what was in the bowl. If the solution touches anything other than the lens, discard it and start again.

After a lens goes in, check your vision and comfort in that eye. Blur or discomfort right after insertion can mean an air bubble is trapped under the lens; the usual fix is to remove it and insert again with the technique you were taught. If you see bubbles often, mention it at your next visit.

If one eye is clearly worse than usual right after insertion, check that the right and left lenses have not been swapped. Many fitters suggest a consistent order, always the same eye first, and separate marked case wells, so mix-ups are less likely on a rushed morning.

Insertion and removal are taught in the office, and practice makes them easier. Tools such as small suction plungers are common; replace them as your fitter advises.

A faint impression ring on the white of the eye after removal is common and usually fades within minutes. If the ring is red, does not fade, or comes with pain, tell your eye care office. If removal is difficult, stay calm and use the method you were taught; call your eye care office if you still can't remove the lens.

Removal technique is taught hands-on in the office because it depends on your lens and eye. The general principles are to stay calm, use the method and tools you were shown, and never force a lens that will not come out or that hurts.

If you cannot remove a lens, or removal causes pain or redness, contact your fitter or eye care office promptly. Ask during training what to do after hours.

Use only the removal method and tools your fitter taught you, and keep a clean, spare removal tool if one was prescribed. Avoid pulling straight off the cornea or pressing hard on the eye. If a lens will not come out, stop forcing it and call your fitter or eye care provider right away, and seek urgent eye care if you cannot reach them, especially if there is pain, redness or blurred vision. Repeated forcing can injure the eye.

Running out of the right product is a common reason people improvise. A little planning avoids that.

Before a trip, check that you have enough of every product in its original container, plus your backup glasses, a spare case and the fitter's phone number. Air travel rules for liquids can affect how you pack solutions, so check them before you go. Storage temperature and expiry dates matter, so look at the labels rather than assuming products are interchangeable abroad.

• Keep spare unopened filling solution and your disinfecting product at home, and pack more than you need for trips.
• Carry backup glasses and your lens case with you.
• Ask your fitter which eye drops, if any, can be used with the lenses in, and how often.
• If you cannot get your usual product, ask your fitter before substituting; do not use tap water, homemade saline or an unapproved solution.

Take the lenses out and contact your eye care clinician promptly if you have eye pain, redness, sudden blur, unusual discharge or light sensitivity. Do not put the lenses back in until you are told it is safe.

When a caregiver handles a child's lenses, both should know the same routine and the same stop rules. A short written sheet from the fitter, kept with the case, reduces mix-ups when a different adult helps. Teens taking over their own care benefit from an adult checking the routine now and then, without making it a test.

Keep the after-hours number for your eye care provider somewhere you can find it without your lenses in, such as saved on your phone, and keep backup glasses within reach of where you remove your lenses.