Successful scleral lens application requires the ability to spread the eyelids open wider than the lens diameter and maintaining fixation to reduce the chance of bubbles under the lens. Below is a step-by-step guide to scleral lens application
• Remove the scleral lens from the case. Rinse with sterile saline or scleral application
solution if necessary.
• The scleral lens bowl must be filled with an approved scleral application solution. To avoid spilling this solution, the lens is usually placed on clean fingers (tripod or two-finger method), a DMV suction cup, or ring inserter.
Scleral lens stands may be used to help with the scleral lens application process.
Provide a stable platform to help prepare the lens for application.
Stands hold the suction cup stable, thus avoiding spillage of the application solution from poor dexterity or tremor. This can reduce the incidence of application bubbles underneath the lens.
Hands free stabilization of the scleral lens allows for the use of the hand(s) to help hold eyelids open.
The use of a non-harmful fixation light can help reduce the reflex of looking away from the scleral lens and improve centration and alignment.
Fill the scleral lens bowl to the brim. Underfilling the lens may increase the chance of bubbles.
Lean over a clean surface to a face-down position so your face is parallel to the floor. This will help keep the scleral lens from easily spilling any filling solution.
Spread your eyelids open with your fingers, pinning the upper eyelid to the brow and pulling the lower eyelid away from the eye itself.
Slowly, but efficiently, bring the lens closer to the eye while maintaining fixation to reduce the chance of bubble entrapment.
When the solution touches the corneal surface continue to bring the lens closer to the eye until it makes full contact. Release the eyelids to enclose around the lens, creating a semi-seal.
If unable to hold the eyelids, bring the lens closer to the eye, and maintain fixation all at once, it may be helpful to use a scleral lens application stand. By placing the lens on the stand, it frees both hands to help hold the scleral lens. These stands may also utilize a fixation light.
A more viscous filling solution can also be used to minimize bubbles. A thicker non-preserved lubricant can be added to the lens bowl.
SCLERAL LENS REMOVAL
To remove a scleral lens, a small DMV suction cup should be applied towards the edge of the
scleral lens and then tilted away from the eye to remove the lens.
If the plunger is positioned appropriately but the lens is still not coming off the eye, apply a small amount of pressure to the eye using a finger pressed against the lower eyelid below the lower edge of the lens. This will help break the seal of the lens.