Specialty Lenses for Irregular Corneas

Scleral Lenses for Keratoconus and Irregular Corneas

Large-diameter gas-permeable lenses that vault the cornea and hold a reservoir of fluid against the eye. Fitted at our offices in Pasco and Sunnyside, Washington and Hermiston, Oregon.

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Quick answer

What a scleral lens does

A scleral lens vaults completely over the cornea and lands on the white of the eye, replacing an irregular corneal surface with a smooth optical one. The gap underneath is filled with sterile saline, so the cornea sits in fluid for as long as the lens is worn.

Why that matters for an irregular cornea

When a cornea is cone-shaped, scarred or reshaped by surgery, light entering the eye is distorted before it ever reaches the retina. Glasses cannot correct that distortion, and a soft lens simply drapes over it. Because a scleral lens never touches the cornea, the eye looks through the lens and the fluid layer instead of through the irregular surface.

Fitted, not dispensed

Scleral lenses are custom devices. Fitting is done on the eye with diagnostic lenses, usually over several visits, and the design is adjusted to your corneal shape rather than selected from a standard range. Whether a scleral lens is the right answer for your eyes is determined at the evaluation.

Scleral Lens Evaluation

  • Corneal shape assessment
  • Diagnostic lens fitted on the eye
  • Custom lens design for your cornea
  • Insertion and removal training
  • Follow-up and fit review
Book a Scleral Lens Evaluation

Fitting fees are quoted after the evaluation, because they depend on the lens design and the complexity of the fit. We check your benefits and give you the cost in writing before any lens is ordered.

Conditions

Who May Benefit From Scleral Lenses

Scleral lenses are considered when the shape or surface of the cornea, rather than a simple refractive error, is what is limiting vision or comfort.

Keratoconus

As the cornea thins and steepens into a cone shape, glasses and standard soft lenses often stop giving usable vision. A scleral lens vaults the irregular surface entirely and replaces it with a smooth optical surface.

Corneal ectasia

Progressive thinning and bulging, including ectasia that develops after refractive surgery, changes the shape light passes through. Scleral lenses are one option for correcting the resulting irregular astigmatism.

Irregular astigmatism

When astigmatism is irregular rather than regular, a spectacle cylinder cannot fully correct it. The tear reservoir under a scleral lens neutralizes much of that irregularity.

Corneal scarring

Scarring from infection, injury or previous surgery leaves an uneven surface. A scleral lens can mask surface irregularity so light focuses more evenly.

After LASIK, RK or corneal surgery

Post-surgical corneas can be flat centrally, steep peripherally or otherwise atypical. Scleral lenses are designed around the eye rather than assuming a normal corneal shape.

Severe ocular surface disease

For some patients with severe dry eye or ocular surface disease who cannot comfortably tolerate other lenses, a scleral lens holds fluid against the cornea through the wearing day. Whether this is appropriate depends on your diagnosis.

Not every patient with these conditions is a scleral lens candidate, and scleral lenses are not the only option for any of them. Your doctor will discuss the alternatives that apply to your eyes.

The process

How a Scleral Lens Fitting Works

1

Corneal evaluation

We examine the ocular surface and measure the shape of the cornea. This is where we determine whether a scleral lens is a reasonable option for your eyes at all, and what design to start from.

2

Diagnostic lens on eye

Fitting is done with diagnostic lenses rather than from measurements alone. We assess how the lens vaults the cornea, how it lands on the conjunctiva, and how the fluid reservoir behaves.

3

Customization

Diameter, sagittal depth, landing zone and optics are adjusted to your eye. More than one iteration is normal, particularly for highly irregular corneas.

4

Insertion and removal training

You are taught to fill, insert and remove the lens, and to clean and store it, before you take lenses home. Most patients need a little practice before it feels routine.

5

Follow-up

We recheck the fit and the health of the eye after you have worn the lenses in daily life, and adjust the design if needed. Scleral wear is monitored on an ongoing basis, not fitted once and forgotten.

Scleral Lenses and Severe Dry Eye

Because a scleral lens holds fluid against the cornea throughout wear, it is sometimes used for patients with severe ocular surface disease who have not been able to wear other lenses comfortably. It is one option among several, and it does not treat the underlying cause of dry eye.

For most patients, the first step is finding out why the eyes are dry. That work happens at our Dry Eye Center, where evaluation and in-office treatment are aimed at the cause rather than at masking symptoms.

For referring providers

Referring a patient for scleral lens fitting

We accept referrals from optometrists, ophthalmologists, corneal specialists and other providers for keratoconus, corneal ectasia, irregular astigmatism, post-surgical corneas and severe ocular surface disease. Fitting findings are sent back to you, and we are glad to co-manage.

Referral information Contact the practice
Questions

Scleral Lenses: Frequently Asked Questions

What is a scleral lens?
A scleral lens is a large-diameter rigid gas-permeable contact lens. Rather than sitting on the cornea like a standard contact lens, it vaults completely over the cornea and lands on the sclera, the white of the eye. The space between the back of the lens and the cornea is filled with sterile saline, creating a fluid reservoir that stays in place during wear.

How is a scleral lens different from a normal contact lens?
A soft contact lens drapes over the cornea and takes on its shape, so an irregular cornea produces irregular optics. A scleral lens does not touch the cornea at all. It replaces the front optical surface of the eye with a smooth, rigid one and holds fluid underneath, which is why it is used for corneas that soft lenses cannot correct well.

What is the fluid reservoir for?
Two reasons. Optically, the saline layer fills in surface irregularity so light passes through a smooth interface. Physiologically, it keeps the corneal surface in continuous contact with fluid during wear, which is why scleral lenses are sometimes considered for patients with significant ocular surface disease.

Am I a candidate for scleral lenses?
That depends on your corneal findings, the health of your ocular surface and what you need to be able to see and do. Scleral lenses are commonly considered for keratoconus, corneal ectasia, irregular astigmatism, corneal scarring, post-surgical corneas and some cases of severe ocular surface disease. Candidacy is determined at a fitting evaluation, not in advance.

Will scleral lenses give me 20/20 vision?
We cannot promise a specific acuity. What a scleral lens does is remove the irregular corneal surface from the optical path, which for many patients with irregular corneas gives clearer and more stable vision than glasses or soft lenses. Your result depends on the condition of your cornea, the health of the rest of the eye, and how much of your vision loss is caused by surface irregularity versus something else.

Are scleral lenses comfortable?
They are generally well tolerated. Because the lens rests on the sclera rather than the more sensitive cornea, many patients find them more comfortable than smaller rigid lenses. There is an adaptation period, and comfort varies between individuals.

How long does it take to get used to them?
Most of the learning curve is handling, filling, inserting and removing the lens, rather than the lens itself feeling foreign. Expect some practice in the first days and a follow-up visit to review both the fit and your technique.

How do I take care of scleral lenses?
They are cleaned and stored daily in the solutions we specify for your lens material, and filled with sterile preservative-free saline for insertion. We go through the routine with you before you take lenses home and review it at follow-up.

How much do scleral lenses cost?
Scleral lens fitting is quoted after the evaluation, because the fee depends on the design, the complexity of the fit and how many lenses the eye needs. We will give you the cost in writing before any lens is ordered. We do not publish a single price here because it would be misleading for a service that is genuinely different from patient to patient.

Does insurance cover scleral lenses?
Sometimes. Medically necessary contact lenses for conditions such as keratoconus are covered by some medical and vision plans, often at a different benefit level from routine contact lenses. Coverage depends on your specific plan and diagnosis. We can check your benefits before you commit to a fitting.

Do you fit scleral lenses for dry eye?
For some patients with severe ocular surface disease who have not done well with other options, yes, when it is clinically appropriate. For most dry eye patients the first step is treating the underlying cause, which is what our Dry Eye Center is for. Scleral lenses are one tool, not the starting point for everyone.

Can my eye doctor refer me for a scleral lens fitting?
Yes. We accept referrals from optometrists, ophthalmologists, corneal specialists and other providers for scleral lens fitting, and we will send the fitting findings back to the referring provider. Co-management is welcome.

Where do you fit scleral lenses?
Scleral lens fitting is arranged through our offices in Pasco and Sunnyside, Washington and Hermiston, Oregon. Because fitting involves diagnostic lenses and several visits, call the office you plan to attend so we can schedule the right appointment type.

Medically reviewed

Reviewed by Ryan Ngo, OD, residency-trained in ocular disease. Last reviewed August 29, 2026. This page is general health information, not medical advice, and does not create a doctor-patient relationship.

Schedule a Scleral Lens Evaluation

Fitted at our offices in Pasco and Sunnyside, Washington and Hermiston, Oregon. Call the office you plan to attend so we can book the right appointment type.

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