Scleral Lens Comfort: Removal Soreness, Itching After Wear and Lenses That Rotate

Scleral lenses can change life for people with keratoconus and other tricky corneas. But "they work" and "they feel great" aren't always the same thing. A lens that gives sharp vision can still sting on the way out, leave your eyes itchy at night, or feel different after years of easy wear.

This week, Reimbold Eye Group patients asked about exactly those moments. Here's what's usually going on, and what a fitter can change to make lenses feel better.

Are scleral lenses easier to take out than small rigid lenses?

For many people, yes. Small rigid gas permeable (RGP) lenses sit right on the cornea and often come out with a "blink and pull" move that takes practice. Scleral lenses are larger and rest on the white of the eye. Most people remove them with a small suction tool called a plunger.

• Use a vented scleral plunger, not a solid RGP one.
• Place it near the bottom edge of the lens, not the center.
• Tilt gently to let air under the edge, then lift out.
• Some people prefer a "no tool" method with their lids. Your fitter can teach both.

Fear of removal is normal at first. Most people feel confident within a couple of weeks with coaching. If you're nervous, ask for an extra training visit.

Why do my hard lenses for keratoconus hurt when I take them out?

Taking lenses out should not hurt. When it does, the cause is usually one of these:

• Strong suction. A rigid lens can grip the eye tightly, especially after hours of wear. A drop of saline first can help loosen it.
• Tool placement. A plunger placed in the center of a small RGP, or pulled straight off, can tug on the cornea.
• A dry surface. By evening the eye may be drier, so removal feels rougher.
• Fit. A lens that sits too tight or rubs the cone may leave the eye sore. That's a fit question, not something to push through.

If removal leaves you with pain, redness, or blur that lasts, leave the lens out and call your fitter soon.

Why do my eyes itch after I take out my sclerals?

Itching after removal is very common and has a few usual causes:

• Allergies. Pollen and dust can collect on the lens during the day. Fall in Georgia is a busy allergy season.
• Solution sensitivity. Some people react to a cleaner or storage solution. Switching products, with your fitter's okay, may help.
• Lens edge pressure. The lens edge rests on the white of the eye. When it comes off, blood flow returns and the area can feel itchy or look a bit pink for a short while.
• Lid issues. Oily, inflamed lids can add to itchy, gritty eyes.

A cool compress after removal often feels great. Try very hard not to rub — rubbing is especially risky with keratoconus. Tell your fitter if the itch is daily, because there are good options to treat it.

Why do new sclerals feel fine at first and then ache hours later?

When a new lens feels good at insertion but starts to ache after a few hours, the fit often needs fine-tuning. Over the day, a scleral lens can "settle" slightly onto the eye. If it settles too much, the lens may press on the white of the eye or get too close to the cornea.

Clues to share with your fitter:

• How many hours in the ache starts.
• Whether you see a red ring where the edge sits.
• Whether vision also gets foggy.
• How the eye looks and feels after removal.

Small changes to the lens edge or depth often fix this. Please don't just "wear through" pain.

My sclerals were comfortable for years. Why are they bothering me now?

Lenses and eyes both change over time. Common reasons include:

• An aging lens. Deposits and tiny scratches build up. Many sclerals need replacing every one to two years.
• Dry eye or lid changes, which often show up with age, hormones, or new medicines.
• A changing eye. The cornea or the white of the eye can shift a little, so an old fit may not match anymore.
• A new solution or routine. Even a different brand of saline can matter.

A fit check usually finds the cause quickly.

Why is my vision clearer when my lens is turned a little?

That's a helpful clue, not a mistake. Some eyes have leftover astigmatism even with a scleral lens on, or the white of the eye isn't perfectly round, so the lens sits better in one position. When the lens rotates to a certain angle, the optics may line up better with your eye.

This can often be fixed. A fitter can mark the lens, measure how it sits, and order a design that stays in one position with extra correction built in. Tell your fitter which way the lens turned when vision looked best.

How we help at Reimbold Eye Group

At Reimbold Eye Group in Alpharetta, scleral and specialty lenses are a big part of what we do. Dr. Susan Reimbold looks at how your lenses feel at the end of the day, not just in the exam chair. We fine-tune fits, coach removal, and treat the dry eye and lid issues that often sit behind discomfort. Learn more about scleral lens fittings and dry eye treatment. Related reading: keratoconus after diagnosis, contact lenses for astigmatism and our contact lens insertion and removal guide.

Visit us at 4180 Old Milton Pkwy 1-D, Alpharetta, GA 30005, or call 770-776-9000. We're closed Mondays.

Frequently asked questions

Should scleral lenses ever hurt?

No. Mild awareness is normal at first, but pain is a sign the fit or routine needs a change.

Is a pink ring after removal normal?

A faint mark that fades within about an hour can be normal. A deep red ring or one that lasts should be checked.

How often should I replace my sclerals?

Many people replace them every one to two years. Your fitter will tell you what fits your lens and eye.

Can I use any drops with sclerals?

Ask your fitter first. Some drops shouldn't go under or over the lens.

When should I call right away?

Remove the lenses and call the same day for pain, strong redness, light sensitivity, discharge, or blur that doesn't clear.

Book a scleral lens comfort check at Reimbold Eye Group

If your sclerals sting, itch, or just don't feel like they used to, we can help. Book online with Reimbold Eye Group in Alpharetta or call 770-776-9000.