Mastering Scleral Lens Insertion and Removal: A Comprehensive Guide

Scleral lenses offer a life-changing vision correction solution for individuals with corneal irregularities, dry eye, and other ocular surface diseases. However, successfully wearing scleral lenses depends heavily on mastering the insertion and removal techniques. This comprehensive guide provides detailed, step-by-step instructions to help you confidently manage your scleral lenses and enjoy clear, comfortable vision.

Who Benefits from Scleral Lenses?

Scleral lenses are often prescribed for individuals with the following conditions:

* **Keratoconus:** A progressive thinning and bulging of the cornea.
* **Corneal Ectasia:** A weakening and distortion of the cornea, often after refractive surgery (like LASIK).
* **Dry Eye Disease:** Severe dry eye that doesn’t respond adequately to traditional treatments.
* **Graft-versus-Host Disease (GVHD):** A complication after bone marrow transplantation that can affect the eyes.
* **Stevens-Johnson Syndrome (SJS):** A rare, serious disorder that affects the skin and mucous membranes, including the eyes.
* **Irregular Astigmatism:** An uneven curvature of the cornea that causes blurred vision.
* **Corneal Scarring:** Scarring on the cornea from injury or infection.

Why Proper Insertion and Removal are Crucial

Correct insertion and removal techniques are vital for several reasons:

* **Comfort:** Proper insertion minimizes air bubbles, debris, and discomfort under the lens.
* **Vision Clarity:** A well-centered lens ensures optimal vision correction.
* **Eye Health:** Gentle handling reduces the risk of corneal abrasions, infections, and other complications.
* **Lens Integrity:** Correct removal techniques prevent damage to the delicate lens material.

Preparing for Insertion

Before you begin, gather the necessary supplies and prepare your workspace:

1. **Clean Hands:** Wash your hands thoroughly with soap and water. Rinse and dry them with a lint-free towel.
2. **Clean Workspace:** Ensure you have a clean, well-lit area to work in. A mirror is essential.
3. **Scleral Lens Case and Solution:** Have your scleral lens case with fresh, multipurpose or saline solution readily available.
4. **Insertion Device (Optional):** A scleral lens plunger or DMV (Dry Eye Vent Mount) tool can aid in insertion. These devices help hold the lens steady and centered.
5. **Preservative-Free Saline Solution:** Use preservative-free saline to fill the lens before insertion. This helps cushion the lens and prevents air bubbles.
6. **Mirror:** A well-lit mirror is essential. Some people prefer a lighted magnifying mirror.

Step-by-Step Scleral Lens Insertion Guide

Follow these steps carefully to insert your scleral lenses:

1. **Inspect the Lens:** Remove the lens from its case and carefully examine it for any debris, scratches, or tears. If you find any damage, do not use the lens.
2. **Rinse the Lens:** Rinse the lens with preservative-free saline solution to remove any lingering debris.
3. **Fill the Lens with Saline:** Place the lens, bowl-up, on the tip of your index finger or on the insertion device. Fill the lens to the brim with preservative-free saline solution. Overfilling is better than underfilling, as it helps prevent air bubbles.
4. **Position Yourself:** Position yourself comfortably in front of the mirror. Ensure you have good lighting.
5. **Stabilize Your Eyelids:**
* **For the Right Eye:** Use the middle finger of your *left* hand to gently pull up your upper eyelid, lifting it away from your eye. Use the middle finger of your *right* hand to gently pull down your lower eyelid.
* **For the Left Eye:** Use the middle finger of your *right* hand to gently pull up your upper eyelid, lifting it away from your eye. Use the middle finger of your *left* hand to gently pull down your lower eyelid.
* **Important:** Keep your eyelids wide open and close to the rims of your eye sockets. This prevents blinking during insertion.
6. **Focus on a Target:** Look directly at a fixed point in the mirror or a target in the distance. This helps to keep your eye steady.
7. **Insert the Lens:** Slowly and steadily bring the lens towards your eye, keeping your gaze fixed on the target. Gently place the lens onto your eye. Ensure the entire lens clears your eyelids before releasing them.
8. **Release Your Eyelids:** Once the lens is in place, slowly release your eyelids.
9. **Check for Bubbles:** Immediately check in the mirror for any air bubbles trapped under the lens. If you see bubbles, try blinking a few times or gently massaging your eyelids to dislodge them.
10. **Troubleshooting Bubbles:**
* **Small Bubbles:** Small bubbles often disappear on their own within a few minutes.
* **Large Bubbles:** If a large bubble persists, remove the lens, refill it with saline, and reinsert it. Tilting your head slightly forward while inserting can also help.
11. **Repeat for the Other Eye:** Repeat the process for your other eye.

Using an Insertion Device (Plunger or DMV)

An insertion device can be particularly helpful for individuals who have difficulty stabilizing the lens or keeping their eyelids open.

1. **Attach the Lens:** Place the scleral lens, bowl-up, onto the suction cup of the plunger or DMV. Ensure the lens is centered and secure.
2. **Fill with Saline:** Fill the lens to the brim with preservative-free saline solution.
3. **Stabilize Your Eyelids:** Follow the same eyelid stabilization technique as described above.
4. **Insert the Lens:** Slowly bring the plunger or DMV towards your eye, keeping your gaze fixed on a target. Gently place the lens onto your eye.
5. **Release the Lens:** Once the lens is in place, gently detach the plunger or DMV from the lens. You may need to twist or wiggle it slightly.
6. **Release Your Eyelids:** Slowly release your eyelids.
7. **Check for Bubbles:** Check for air bubbles and troubleshoot as needed.

Scleral Lens Removal Guide

Removing scleral lenses requires a different set of techniques. Again, cleanliness and gentle handling are crucial.

1. **Clean Hands:** Wash and dry your hands thoroughly.
2. **Prepare Your Workspace:** Ensure you have a clean, well-lit area and a mirror.
3. **Suction Cup Remover (Recommended):** A small suction cup remover is the easiest and safest way to remove scleral lenses. These are readily available and inexpensive.
4. **Alternative Method (Without Suction Cup):** If you don’t have a suction cup, you can use your eyelids to dislodge the lens. However, this method requires more practice and caution.

Step-by-Step Scleral Lens Removal with a Suction Cup

1. **Moisten the Suction Cup:** Lightly moisten the tip of the suction cup with saline solution. This helps it adhere to the lens.
2. **Stabilize Your Eyelids:** Use the same eyelid stabilization technique as described for insertion. Keep your eyelids wide open and close to the rims of your eye sockets.
3. **Position the Suction Cup:** Look straight ahead in the mirror. Gently position the suction cup on the lower portion of the lens, slightly off-center.
4. **Apply Gentle Pressure:** Apply gentle, steady pressure to the suction cup until it adheres to the lens. You should feel a slight suction.
5. **Break the Seal:** Once the suction cup is securely attached, gently tilt your head down and slowly pull the lens away from your eye. You may need to slightly wiggle the suction cup to break the seal between the lens and your eye.
6. **Catch the Lens:** As the lens comes off your eye, catch it in your other hand or over a clean towel to prevent it from falling and getting damaged.
7. **Clean and Store the Lens:** Immediately clean the lens with the recommended cleaning solution and store it in its case with fresh multipurpose or saline solution.
8. **Repeat for the Other Eye:** Repeat the process for your other eye.

Scleral Lens Removal Without a Suction Cup (Eyelid Method)

This method requires practice and should be performed with extreme caution to avoid scratching your cornea.

1. **Stabilize Your Eyelids:** Use your fingers to stabilize both eyelids, pulling them back towards your ears.
2. **Widen Your Eyes:** Open your eyes as wide as possible.
3. **Blink Forcefully:** Forcefully blink, squeezing your eyelids together. The pressure from your eyelids should dislodge the lens.
4. **Catch the Lens:** Be prepared to catch the lens as it comes out. Have a clean hand or towel ready.
5. **Alternative Eyelid Technique:** If blinking doesn’t work, try using your upper eyelid to gently push down on the top edge of the lens while simultaneously pulling your lower eyelid upwards. This can help to lift the lens off your eye.
6. **Important:** If you experience any pain or discomfort, stop immediately and try using a suction cup remover or consult your eye care professional.

Troubleshooting Removal Problems

* **Lens Stuck:** If the lens feels stuck, try blinking a few times to re-wet the surface. You can also instill a few drops of preservative-free saline solution.
* **Suction Cup Not Adhering:** Ensure the suction cup is clean and slightly moist. Apply firm, steady pressure.
* **Lens Falling Out:** Be prepared to catch the lens as it comes out. Perform the removal over a clean surface or hold your hand underneath.

Cleaning and Storing Scleral Lenses

Proper cleaning and storage are essential for maintaining the health of your eyes and the longevity of your lenses.

1. **Cleaning Solution:** Use only the cleaning solution recommended by your eye care professional. Avoid using tap water or saliva.
2. **Rub and Rinse:** After removing the lenses, rub them gently with your fingertips and the cleaning solution to remove any debris or deposits. Rinse thoroughly with saline solution.
3. **Storage Solution:** Store the lenses in their case with fresh multipurpose or saline solution. Never reuse solution.
4. **Case Hygiene:** Clean your lens case regularly with soap and water, and allow it to air dry completely.
5. **Replace Solution Daily:** Always use fresh solution when storing your lenses. Discard the old solution each day.
6. **Regular Enzyme Cleaning:** Your eye care professional may recommend periodic enzyme cleaning to remove protein deposits that can build up over time.

Important Tips and Precautions

* **Follow Your Doctor’s Instructions:** Always follow the specific instructions provided by your eye care professional.
* **Start Slowly:** Be patient with yourself. It may take time to master the insertion and removal techniques.
* **Don’t Force It:** Never force the lens in or out. If you encounter resistance, stop and try again later.
* **Maintain Hygiene:** Always wash your hands thoroughly before handling your lenses.
* **Use Preservative-Free Solutions:** Avoid using solutions containing preservatives, as they can irritate your eyes.
* **Replace Lenses as Directed:** Replace your lenses according to your eye care professional’s recommendations.
* **See Your Doctor Regularly:** Schedule regular eye exams to monitor your eye health and the fit of your lenses.
* **Avoid Tap Water:** Never rinse or store your lenses in tap water, as it can contain harmful microorganisms.
* **Listen to Your Body:** If you experience any pain, redness, blurred vision, or excessive tearing, remove your lenses and consult your eye care professional immediately.
* **Makeup Application:** Insert your lenses *before* applying makeup to avoid contaminating them with cosmetic particles. Remove your lenses *before* removing your makeup.
* **Lubricating Drops:** Use lubricating drops recommended by your eye care professional throughout the day to keep your eyes comfortable and hydrated.

When to Seek Professional Help

Contact your eye care professional immediately if you experience any of the following:

* **Persistent Pain or Discomfort:** Pain that doesn’t subside after removing the lenses.
* **Redness or Inflammation:** Significant redness or swelling of the eye.
* **Blurred Vision:** Sudden or worsening blurred vision.
* **Excessive Tearing or Discharge:** Unusual tearing or discharge from the eye.
* **Light Sensitivity:** Increased sensitivity to light.
* **Foreign Body Sensation:** Feeling like something is stuck in your eye.
* **Lens Damage:** A torn, scratched, or broken lens.

Conclusion

Mastering scleral lens insertion and removal takes practice and patience. By following these detailed instructions and tips, you can confidently manage your lenses and enjoy the numerous benefits they offer. Remember to always prioritize hygiene, handle your lenses gently, and consult your eye care professional if you have any concerns. With proper care and technique, scleral lenses can significantly improve your vision and quality of life.