Lens Application and Care
Scleral lenses completely vault the cornea creating a liquid bandage that relieves DES symptoms. Therefore, sterile saline is used to fill the lens before insertion. Solutions most commonly used in the USA are Unisol-4 (Alcon), which is pH buffered for ophthalmologic use. In addition, some practitioners recommend 0.9% NaCl sterile inhalation vials. For insertion, the lens should be completely filled with the solution, the patient's face positioned parallel with the plane of the lens, and the lens held with the patient's fingers or a plunger. If air bubbles become trapped under the lens during insertion, the lens should be removed, refilled with solution, and re-inserted. Removal of the lens, similarly, can be achieved with the patient's fingers or a plunger. It is important that patients are trained in proper insertion and removal techniques, as many patients experience difficulty with these steps. One report noted that 20% of scleral lens wearers complained of difficulty with placement of lenses, which likely contributed to discontinuation of use.
Cleaning and nightly disinfection can vary among practitioners but is generally similar to rigid gas permeable lens care and cleaning. Alcohol-based solutions are most often used for cleaning, whereas general contact lens storage solutions or hydrogen peroxide solutions may be used nightly for disinfection and storage purposes.