How To Put On Sclera Contacts: A Professional Guide To Safe Insertion
Sclera contact lenses cover the entire visible portion of the eye, requiring a specialized technique that involves filling the lens bowl with sterile preservative-free saline to eliminate air bubbles before application. Success depends on maintaining complete eyelid control, utilizing proper suction-based tools, and ensuring the cornea remains centered within the vault of the lens during the placement process.
Essential Preparation and Sterile Environment Standards
Before attempting to insert sclera lenses, practitioners and users must establish a sterile, well-lit environment to prevent the introduction of pathogens into the ocular surface. Sclera lenses, due to their large diameter (typically 15mm to 24mm), require significantly more precision than standard corneal lenses. The process involves creating a fluid-filled chamber, meaning any dust, oils, or micro-particulates trapped under the lens will cause immediate discomfort and potential abrasions.
- Essential Gear: High-quality sclera lens plunger (large diameter), preservative-free sterile saline (0.9% sodium chloride), lint-free towels, and a magnifying mirror.
- Hygiene Requirements: Hands must be washed with non-perfumed, antimicrobial soap and dried with a lint-free cloth to ensure no fibers adhere to the fingertips or the lens surface.
- Time Commitment: Allow 15–20 minutes for the initial attempts, as muscle memory for lid retraction is the primary hurdle for new users.
- Prerequisite Knowledge: Users must understand the distinction between "wetting" solutions and "filling" solutions; only preservative-free saline should be used to fill the bowl of the lens to prevent corneal staining.
The Technical Workflow for Sclera Lens Insertion
Step 1: Lens Preparation and Cleaning
Begin by removing the lens from its storage case and rinsing it thoroughly with sterile preservative-free saline. Place the lens, concave side up, on the tip of the specialized large-diameter suction plunger. If you do not have a plunger, you may use a tripod grip with your index, middle, and thumb, though this is significantly more difficult for beginners. Inspect the lens edges for chips or debris under bright light before proceeding.
Step 2: The Saline Fill
Fill the bowl of the lens to the brim with preservative-free sterile saline. The goal is to create a slight "meniscus" or dome of fluid that sits above the edges of the lens.
Pro-Tip: Overfilling slightly ensures that no air is trapped inside the lens bowl. If an air bubble forms during insertion, the lens must be removed and the process restarted, as bubbles will cause severe glare and potential corneal hypoxia.
Step 3: Proper Eyelid Retraction
This is the most critical technical step. Use your non-dominant hand to pull the upper eyelid up against the brow bone, ensuring the lashes are pinned back. With the middle finger of your dominant hand (the one holding the plunger), pull the lower eyelid down firmly. Both lids must be retracted beyond the diameter of the lens to prevent them from interfering with the seal.
Warning: If the eyelids are not retracted sufficiently, the lens will push against the lashes or lid margins, causing it to eject or shift, which may lead to surface scratching.
Step 4: Ocular Engagement and Seal
Look directly into the mirror, keeping both eyes open. Slowly move the plunger toward the center of your eye. Ensure the lens makes contact with the sclera evenly. As the lens touches the eye, the fluid will displace, and the suction will naturally pull the lens onto the ocular surface. Once you feel the lens engage, gently release the suction on the plunger by rocking it slightly or squeezing the handle, then remove the tool.
Step 5: Seating Verification
Once the lens is on, do not release your eyelids immediately. Keep them held back for a second to ensure the lens has centered. Slowly release the bottom lid, then the top lid. If the lens feels secure, blink gently to allow the lens to settle into the tear film. If you feel stinging or excessive pressure, remove the lens immediately to inspect for debris.
how-to-insert-scleral-lenses-1 | Littlefield Eye Associates
Technical Specifications and Comparative Material Thresholds
Sclera lenses are manufactured from highly gas-permeable materials to allow oxygen transfer to the cornea despite the large surface area covered. The following table outlines the key technical differences between standard soft lenses and sclera lenses.
| Specification | Standard Soft Lens | Sclera Contact Lens |
|---|---|---|
| Material | Hydrogel / Silicone Hydrogel | High-Dk Rigid Gas Permeable |
| Diameter | 13.5mm – 14.5mm | 15.0mm – 24.0mm |
| Ocular Interaction | Moves with each blink | Vaults over cornea; no movement |
| Lubrication Method | Natural tear exchange | Preservative-free saline reservoir |
| Risk Factor | Low (if cleaned) | Moderate (requires specialized care) |
Troubleshooting Common Insertion and Comfort Failures
Excessive Air Bubbles
Root Cause: The lens was not filled high enough with saline, or the user tilted their head too far during insertion, causing fluid to spill before contact. Actionable Fix: Ensure the lens is filled until the saline domes slightly above the edges. Keep your head parallel to the table surface and look straight down into the mirror to maintain the fluid reservoir during the approach.
Lens Ejection upon Release
Root Cause: The eyelids were not retracted wide enough, and the lid margins pushed the lens off the eye before it could create a vacuum. Actionable Fix: Practice "locking" the lids against the bone structure of the orbital rim. Use a wider grip or a tripod hand position to ensure the lids are pinned completely behind the lens diameter.
Post-Insertion Discomfort or "Fogging"
Root Cause: Presence of microscopic debris, or the saline being used contains preservatives that irritate the ocular surface. Actionable Fix: Flush the eye and the lens with fresh, preservative-free saline. Ensure the lens bowl is perfectly clean before filling. If fogging persists, consult an optometrist to check for "mid-day fogging," which may require a change in lens fit or solution chemistry.
Frequently Asked Questions
Can I use tap water to clean my sclera contacts?
Never use tap water. Sclera lenses must only be cleaned and stored with professional, contact-lens-specific multi-purpose or peroxide-based solutions, and the bowl must be filled with sterile, preservative-free saline. Tap water contains minerals and microorganisms that can lead to severe, sight-threatening eye infections like acanthamoeba keratitis.
How do I know if the lens is centered?
After insertion, look in the mirror and ensure the limbus (the ring where your colored iris meets the white sclera) is completely covered by the lens. If the lens is off-center, you will feel a distinct "tug" or discomfort, and your vision will be blurred; use the suction plunger to gently lift and re-center the lens.
Is it normal for my eye to be red after wearing sclera contacts?
Minor redness can occur due to the physical manipulation of the lids, but persistent or worsening redness is a clinical red flag. If you experience pain, photophobia, or sustained redness, remove the lenses immediately and consult an eye care professional to rule out corneal abrasions or hypoxia.
How long should I wear sclera lenses in a day?
Wearing schedules vary based on the clinical reason for the lenses. While high-oxygen permeability allows for longer wear, initial users should follow a ramp-up schedule starting at 4–6 hours per day, gradually increasing duration only as directed by your optometrist.
Professional Consultation and Maintenance
Mastering the insertion of sclera contacts requires patience and adherence to sterile protocols to protect your vision. Schedule a follow-up assessment with your optometrist to verify lens vaulting and surface health, ensuring your long-term success with these advanced optical devices.
