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An Optometrist's Guide to Inserting and Removing Scleral Lenses

As optometrists, one of the most common questions we get is about how to properly insert and remove scleral lenses. These large-diameter contacts can be tricky to work with, but with a little practice and the right technique, they can be a great option for those with certain eye conditions. One thing to keep in mind is that these are general instructions, and our optometrist may recommend slightly different instructions based on the lens that you have been prescribed. 

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An Optometrist's Guide to Inserting and Removing Scleral Lenses Optometrist

Before You Begin

Washing your hands before inserting scleral lenses 

When dealing with any type of contact lenses including scleral lenses, whether you're putting them in or taking them out, you're going to be touching around your eyes, so make sure you wash your hands thoroughly. Use mild soap so as not to irritate the eyes. 

Drying your hands before inserting scleral lenses

Tap water should never come in contact with your contact lenses as it can lead to serious eye infection. After you have washed your hands, dry them thoroughly. To reduce the chances of getting lint on your lens, use a towel that is lint free. 

Identify which lens is left and right

Next, you want to identify which contact lens you're going to be putting in. It is recommended to insert the contact lens on the dominant hand side, as it is typically more comfortable and easy to control. For example, if you are right-handed, it is recommended to start with the right eye. By doing this, you don't have to worry about remembering which lens is which if you mix them up. Some brands do have little laser markings on them, including little dots that will tell you which eye belongs to which, usually there's one dot for the right eye and sometimes you'll see two dots for the left eye.

Using a plunger or your fingers

There are a few different ways to insert scleral lenses, however, most patients prefer to use a little plunger with a suction cup also called a DMV.  A pro tip is if you get a plunger and it has a rounded of bottom, you can go ahead and use the scissors to snip that off because afterward you will have a DMV that has a little hole in the bottom. And with this little hole you can see a light passing through it and it acts as a guide for you when you're putting in the lens. Another benefit of cutting out the bottom is to make sure that there is no suction on the lens when putting it in. If you are doing this method you will need one plunger for inserting the lens and another for removing the lens. 

If you prefer using your fingers or cannot find your plunger/DMV tool, we recommend using three fingers like a tripod to keep your scleral lens steady and flat. 

Check your lenses for damage 

It is always a good idea to visually check your lens for any chips, scratches, cloudy deposits or buildup or damage before putting them in your eye. As a general rule scleral lenses that are responsibly cleaned and maintained should last you for a year or longer, but it is a good idea to get in the habit of visually checking your lens. If you notice any build up, follow the instructions our eye doctor provided you for cleaning your lenses. If you notice any damage at all, visit our optometrist before using your lenses to prevent possible abrasions, pain, or infections. 

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Inserting Scleral Lenses

Using a mirror to insert scleral lenses 

Many patients find it easier to place a mirror on their table and look down at the mirror when inserting their scleral lens. 

Place the lens on your finger or plunger

Now put the lens on the plunger or at the tip of your finger.

Fill the bowl completely with non-preserved saline solution 

It is very important not to use a multipurpose solution such as those used for other types of contact lenses, that solution will have preservatives and these preservatives will get trapped on the eye and that can lead to a chemical burn and irritation. Speak with our eye doctor about the recommended non-preserved saline solution.

Now you'll need to fill the bowl of the lens completely all the way to the top. That way you can kind of see a bubble of fluid forming on the top. If you don't fill the bowl completely, then you're likely going to get a bubble when you apply the lens and then you're not going to see well and the lens is going to move and it won't be as comfortable.

Hold your face parallel to the floor/table and look at the mirror

Now inserting the Scleral Lens you want to have your face completely parallel to the floor or table. Some people find using a mirror or something as a fixation target on the counter can help you with inserting the lens.

Hold open your eyelids

Use your non-dominant hand to hold your eyelids open, while using your dominant hand to either hold the plunger or use your fingers as a tripod. 

Place the lens in the eye 

Place the lens in your eye and as soon as you feel the saline coming in contact with your eye press gently and then let go of the lens. Then you can repeat this step with the other eye.  

Removing Scleral Lenses

Removing Scleral Lenses

Wash Hands

Start by washing your hands thoroughly with soap and water to remove any dirt, oils or other substances that may have come into contact with your hands. This is important because anything on your hands can easily transfer to your eyes and cause irritation or infection.

Find Well-Lit Area

Find a well-lit area, and look straight ahead. This will help you see what you're doing and prevent you from accidentally poking or scratching your eye. If desired, you can position yourself in front of a mirror for better visibility.

Choose Removal Method

Choose the removal method you prefer: either with your fingers or with the aid of a plunger. Both methods are effective and it's up to you which one you find easiest to use.

Wet Plunger Tip (if using plunger)

If you're using a plunger, wet the tip with saline solution. This will help prevent the plunger from sticking to your lens, and also help loosen the lens from your eye. Place the plunger onto the lower third of the lens, making sure it's securely attached.

Remove Lens with Plunger (if using plunger)

Gently press the plunger onto your eye, and then pull up and out to remove the lens. This method uses suction to release the lens from your eye. It's important to be gentle and not to pull too hard, as this can cause discomfort or even damage to your eye.

Remove Lens with Fingers (if using fingers)

If you're using your fingers, place two fingertips on either side of the lens. This will give you good control over the lens and help you avoid accidentally poking or scratching your eye.

Gently break the seal from your eye and remove the lens by lifting it off the eye. This can be done by gently sliding your fingers under the edge of the lens and lifting it up. It's important to be gentle and not to pull too hard, as this can cause discomfort or even damage to your eye.

Be Prepared to Catch Lens

Be ready to catch the lens as it pops out. Scleral lenses are large and can be somewhat difficult to handle, so it's important to have your hands ready to catch the lens as it comes out.

Repeat the process for the other eye if necessary.

Clean and Store Lenses

After removing both lenses, clean and store them as directed by your eye care professional. Proper care and storage of your lenses will help ensure they last a long time and remain comfortable to wear.

Removing Scleral Lenses

Removing Scleral Lenses

  • Scleral lenses can correct a wide range of vision problems, including nearsightedness, farsightedness, astigmatism, and presbyopia.
  • They create a fluid-filled space between the lens and the eye, which helps to provide a stable, clear, and comfortable vision.
  • Scleral lenses can also be used to manage corneal conditions, such as keratoconus, corneal ectasia, or corneal scars, that cannot be treated with traditional soft contact lenses or eyeglasses.
  • By vaulting over the cornea and covering the sclera, scleral lenses can provide a protective barrier for the cornea, reducing the risk of dry eye, corneal abrasion, or infection.
  • They can also improve the appearance of eyes with irregular corneas, providing a more symmetrical and aesthetically pleasing look.
  • Scleral lenses can also be used to manage ocular surface diseases, such as dry eye, by providing a moist environment for the cornea and reducing symptoms such as itching, burning, and tearing.
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Common Questions

Scleral lenses can be relatively easy to remove with the proper technique. For new wearers, guidance from an eye doctor is essential in learning the correct method. Individual experience may vary, and practice often leads to increased comfort in removal.
Removing scleral lenses with your fingers requires clean hands and a mirror. Gently pinch the lens with the thumb and forefinger, or use a plunger if provided. Instructions during a contact lens exam with an eye doctor or keratoconus specialist may include personalized techniques specific to the lens type and patient's eye shape.
Showering with scleral lenses is generally not recommended, as tap water may contain contaminants that could adhere to the lenses or irritate the eyes. Specific care instructions provided by an eye doctor during a contact lens exam should be followed.
The wearing time for scleral lenses may vary between individuals, usually ranging from 12-14 hours a day. Your eye doctor will provide personalized recommendations during a contact lens exam based on your unique needs and lens material.
Falling asleep with a scleral lens might cause reduced oxygen to the cornea, leading to potential discomfort or even infection. It's advised to remove them before sleeping. If an accidental sleep occurs with the lens in, consulting with an eye doctor is essential to ensure no harm to the eyes.
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Schedule a Contact Lens Exam

If you're considering scleral lenses as a solution to improve your vision, it's important to schedule a comprehensive contact lens exam with our eye care professional. This exam will ensure that scleral lenses are the right choice for you and that they will be properly fitted to ensure optimal comfort and vision. Our optometry clinic is dedicated to providing top-notch eye care and we have a team of experienced eye care professionals who are ready to assist you.

 

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