Scleral lenses (SLs) are becoming increasingly popular for the correction of irregular astigmatism for individuals who have corneal irregularity and for protection of the ocular surface for individuals with ocular surface disease. Nonetheless, scleral lens complications may occur if the underlying condition is not regularly monitored.

A recent case series evaluated complications from poorly fitted SLs.¹ In addition to demonstrating complications that may arise from mechanical interactions between a scleral lens and the ocular surface, these cases underscore the importance of regular aftercare evaluations.

Disease progression or scleral lens-induced alterations in ocular surface contour may make an initially well-fitted SL unacceptable. All cases in this series were initially fit with small-diameter scleral lenses. Refitting each patient with a larger-diameter lens improved SL and ocular surface alignment, resulting in improved corneal and limbal clearance in all cases.

This case series emphasized that SLs should be removed and the ocular surface carefully evaluated with vital dye staining to identify evidence of lens-induced mechanical trauma. Clinical findings that are atypical for the underlying disease process may indicate a suboptimal SL fit.

Appropriate modifications to SL design may allow patients to resume successful SL wear. However, both lens performance and the underlying ocular condition should be reassessed at regularly scheduled intervals to identify new concerns and, in individuals who have experienced complications, to monitor for recurrence despite lens modification.

In this case series, corneal and ocular surface health improved after refit with larger-diameter scleral lenses with central fluid reservoir depths ranging from 90 µm to 400 µm. No further complications were observed following refitting.

The complications described in this series may have been exacerbated by inadequate aftercare visits. These cases reinforce the importance of routine scleral lens aftercare. Timely follow-up may allow practitioners to identify and address suboptimal lens–ocular surface interactions before clinically significant complications develop.

Reference

1. Nau CB, Nau AC, Fogt JS, Shorter ES, Harthan JS, Schornack MM. Complications of poorly fitted scleral lenses and approaches to continued wear. Eye Contact Lens. 2026;52(10):432-435. doi: 10.1097/ICL.0000000000001306

Melissa Barnett, OD, FAAO, FSLS, practices at Baker Optometry. She also is an International Coaching Federation (ICF) associate certified coach. She has received remuneration from ABB, AbbVie, Alcon, Azura, Bausch + Lomb, BCLA, Bruder, Cloudbreak Pharma, Dompé, Epion, OCuSOFT, ScienceBased Health, STAPLE Program, Tarsus, Tenpoint Pharmaceuticals, and Théa Pharma.

 This content is sponsored by Contamac.