Objective:

To discuss the complexities of managing dry eye in patients using scleral lenses (SLs) and the multifaceted factors contributing to discomfort despite lens fit.

Key Findings:

• Even with optimal lens fit, patients may experience discomfort due to factors beyond the lens itself, necessitating individualized management.
• Eyelid friction and lid wiper epitheliopathy are significant contributors to discomfort in SL wearers.
• Incomplete blinking and environmental conditions can worsen tear film distribution and lens comfort, indicating areas for patient intervention.

Interpretation:

Optimizing tear film and minimizing friction are crucial for enhancing comfort in dry eye patients using scleral lenses, with practical strategies for clinicians.

Limitations:

• The article does not provide specific guidelines for managing eyelid friction or optimizing tear film, highlighting a gap in clinical practice.
• Limited discussion on the long-term effects of scleral lens wear on dry eye symptoms, indicating a need for further research.

Conclusion:

Scleral lenses can be effective for dry eye treatment, but addressing comfort requires a comprehensive approach beyond just fitting, including patient education and individualized care.