Your First Weeks With Scleral Lenses: Insertion, Removal, Cleaning and Fogging

The first time most people hold a scleral lens, the reaction is the same: “That is going in my eye?” They are bigger than regular contacts, and handling them is a skill you learn.

The good news is that it really is a skill, not a talent. Nearly everyone gets it with a little practice, and within a few weeks it becomes part of the morning routine. Here is what to expect and the habits that make it easy.

We go through all of this in person before your lenses go home with you. Think of this as the reference to come back to. If anything here differs from what we told you for your specific lenses, follow our instructions for your eyes.

Set Up Your Space

A good setup prevents most problems.

Wash your hands with a plain, lotion-free soap and dry them with a lint-free towel. Moisturizers and perfumes leave a film on the lens.
Work over a clean towel on a table, not over an open sink. Scleral lenses are tough, but losing one down a drain is not.
Good light and a mirror that lets you look straight down into it help a lot in the beginning.

Putting the Lens In

Rinse the lens with preservative-free saline. Never use tap water, bottled water or saliva.
Place it on your inserter, either the plunger we gave you or a tripod of three fingertips.
Fill the bowl to the brim with preservative-free saline. It should be so full that it bulges a little.
Bend forward until your face is parallel to the floor. This is the single most important step. If your head is tilted, the saline spills and you get a bubble.
Hold your lids open, look straight down at the lens and bring it up onto the eye in one smooth motion.
Release the inserter and slowly lift your head.

If your vision is blurry or there is a dark spot or a ring in your view, there is almost always a bubble under the lens. Take it out, refill it and try again. A lens with a bubble under it is not just blurry, it can also be uncomfortable, so do not leave it in.

OHSU’s Casey Eye Institute in Portland has a clear step-by-step guide with a video that walks through the same technique.

Why the Saline Must Be Preservative-Free

Once a scleral lens is on, very little of your natural tear film flows in and out of the fluid layer. Whatever you filled the lens with sits against your cornea for hours.

Preservatives that are harmless in a quick drop can irritate the cornea when held against it all day. That is why the filling solution must be preservative-free, typically a saline made for scleral lenses (Scleral Lens Education Society, patient FAQ). Use a fresh vial or a bottle designed to stay sterile, and do not top up an old one.

Taking the Lens Out

Wash your hands and look straight ahead into the mirror.
Wet the tip of the removal plunger and hold your lids apart.
Place the plunger near the lower edge of the lens, not in the center. Pulling straight out from the center works against a strong suction.
Tilt the plunger slightly to break the seal, and the lens comes away.

If the lens feels stuck, do not panic and do not yank. A lubricating drop first often helps. You can also press gently on the white of the eye just beside the edge of the lens to let a little air in, which releases the suction.

Cleaning and Storage Every Night

Clean and disinfect your lenses every time you take them out, using the system we recommend for your lens material. Two common approaches:

A rub-and-rinse cleaner followed by a disinfecting storage solution, or
A hydrogen peroxide system such as Clear Care, which needs about six hours in its special case to neutralize before the lens is safe to put in.

A few rules that matter more than they look:

Never store lenses in saline. Saline keeps a lens wet but does not disinfect it.
Never let tap water touch your lenses, case or tools. Tap water can carry Acanthamoeba, an organism that causes a rare but painful, sight-threatening eye infection.
Replace your case about every three months, or each time you open a new bottle of solution.
Replace your plungers about every three months (Scleral Lens Education Society).
Remove lenses before showering or swimming.

What About Midday Fogging?

Some wearers notice their vision slowly getting hazy over the day, as if looking through a smudged window. This is called midday fogging, and it comes from debris building up in the fluid layer under the lens.

It is common. In a survey of scleral lens practitioners, about one in four established wearers reported it (Schornack et al., Contact Lens & Anterior Eye, 2020). The same study found it was not tied to any particular lens design or care product. It was more common in people who also had redness or irritation, which points toward inflammation on the surface of the eye.

What to do:

Remove, rinse, refill and reinsert. Fresh saline clears the fog for most people. Some wearers do this once around midday as routine.
Tell us about it. Fogging that keeps coming back is worth investigating. Sometimes a fit adjustment helps. Sometimes the real fix is treating dry eye or eyelid inflammation, which our Dry Eye Center handles.

A related but different issue is the front of the lens looking smudged or not wetting evenly. That is a lens surface problem, and a cleaning change or a coating often helps.

Eye Drops and Makeup

Prescription eye drops for glaucoma or allergies should go in at least five minutes before you put the lenses on, or after you take them out (Scleral Lens Education Society).
Makeup and face creams go on after the lenses are in, so they do not end up on the lens surface.

When to Call Us Right Away

Take the lenses out and call the office if you have:

Eye pain that does not go away once the lens is out
Redness that is getting worse
Sensitivity to light
Vision that stays blurry after the lens is removed
Any discharge from the eye

These can be signs of an infection or inflammation and need to be checked the same day.

The First Few Weeks Get Easier

Most people need several tries the first few days. By the second or third week, insertion takes a minute or two. Keep your follow-up visits even if everything feels fine, because we check the fit and the health of your cornea under the lens, and early changes do not always cause symptoms.

If you are still deciding whether scleral lenses are right for you, start with scleral lenses for keratoconus and what they cost.

Need Help?

Our patients can call the office that fitted them any time they are struggling with handling. From Kennewick, Richland or West Richland, our Pasco office is closest, at (509) 543-7953. In Eastern Oregon, our Hermiston office is at (541) 567-5283, and Sunnyside is at (509) 839-4575.

This article is general information, not medical advice. Always follow the care instructions your eye doctor gives you for your specific lenses.