Who benefits most from scleral lenses?

People with keratoconus and irregular corneas, post-surgical or scarred corneas including after corneal grafts, and severe dry eye such as Sjogren's or graft-versus-host disease. The lens neutralises irregular shape to restore vision, and the fluid reservoir keeps the surface hydrated all day.

What is fitting and daily life with scleral lenses like?

Scleral fitting is a careful, custom, iterative process. Lenses are applied with preservative-free saline using an insertion tool and removed with a small suction device. Most people become confident handling them within a couple of weeks, with good hygiene and the correct lens-care routine, which we teach.

What are the best eye drops for dry eyes?

There is no single “best” eye drop for dry eye, as treatment depends on the underlying cause. According to the TFOS DEWS III framework, dry eye is a multifactorial disease involving tear film instability, inflammation, and ocular surface damage. For many patients, preservative-free lubricating eye drops are recommended as first-line therapy, particularly for frequent or long-term use. An optometrist can help select drops based on tear quality, evaporation rate, and ocular surface findings.

How often should I use eye drops for dry eyes?

The frequency of eye drop use depends on symptom severity and the type of drop used. Preservative-free drops may be used multiple times per day, whereas preserved drops should be used less frequently to avoid ocular surface irritation. If drops are needed more than 4–6 times daily, clinical guidance generally recommends preservative-free formulations and a dry eye assessment.

Can you use eye drops too often?

Yes. Overuse of preserved eye drops can worsen dry eye symptoms by disrupting the tear film and irritating the ocular surface. DEWS III emphasises minimising preservative exposure and addressing underlying causes—such as meibomian gland dysfunction or inflammation—rather than relying solely on frequent lubrication.

What is the difference between Polytears, Systane, and Hylo eye drops?

Polytears, Systane, and Hylo are lubricating eye drops, but they differ in formulation, viscosity, and preservative status. Some are better suited for mild, intermittent dryness, while others are designed for more persistent symptoms or contact lens wear. Brand name alone does not determine suitability; clinical evaluation does.

Are preservative-free eye drops better for dry eyes?

For many patients, yes. Preservative-free eye drops are commonly recommended for moderate to severe dry eye, frequent use, contact lens wear, and sensitive eyes. DEWS III highlights that long-term preservative exposure can contribute to ocular surface irritation in some people.

Can contact lens wear make dry eye worse?

Contact lenses can exacerbate dry eye symptoms by disrupting tear film stability and increasing evaporation. However, with appropriate lens materials, care systems, and compatible eye drops, many contact lens wearers can remain comfortable. Drops labelled as safe for use with contact lenses are typically preferred during lens wear.

How do I know which eye drops are right for me?

Dry eye is not a single condition. Effective management requires identifying whether symptoms are driven by evaporation, aqueous deficiency, inflammation, or eyelid disease. A dry eye assessment—including tear stability, ocular surface staining, and meibomian gland evaluation—helps guide targeted treatment rather than trial-and-error.

Are thicker eye drops better than watery ones?

Not always. Thicker drops may provide longer relief but can blur vision and may not be ideal for daytime use. Thinner drops may be better tolerated but may require more frequent application. DEWS III supports matching drop viscosity to symptom pattern and lifestyle needs.

Can dry eye be treated without eye drops?

Yes. While lubricating drops are commonly used, DEWS III emphasises a stepwise approach that may include eyelid hygiene, heat therapy, management of meibomian gland dysfunction, environmental modification, and lifestyle changes such as reducing prolonged screen use. Eye drops often remain part of treatment when symptoms affect comfort or visual quality.

When should I see an optometrist for dry eyes?

Seek professional assessment if symptoms are persistent, worsening, or affecting activities such as reading, screen use, or driving. Ongoing reliance on eye drops without improvement suggests an underlying issue that may require targeted treatment.

Scleral Lenses: Life-Changing Vision for Irregular Corneas & Keratoconus

Author: Jagrut Lallu, BOptom (Hons), MSc Specialty Lenses (Hons), FIAOMC. Therapeutic Optometrist & Contact Lens Specialist. Founder, New Zealand Eye Research Centre; Partner, Rose Optometry.

Published by the New Zealand Eye Research Centre. General information only — not a substitute for a personalised assessment.

For people with keratoconus, irregular corneas or severe dry eye, ordinary glasses and soft lenses often cannot deliver clear, comfortable vision. Scleral lenses can be genuinely life-changing — and fitting them is one of the most rewarding parts of my work as a specialty contact lens practitioner.

What is a scleral lens?

A scleral lens is a large-diameter rigid gas permeable lens that vaults right over the cornea and rests gently on the white of the eye (the sclera). The space between the lens and cornea is filled with sterile saline, creating a smooth new optical surface and a fluid reservoir that continuously bathes the eye.

Who benefits most?

Keratoconus and irregular corneas — the lens neutralises the irregular shape, often restoring sharp vision where glasses cannot.
Post-surgical or scarred corneas — including after corneal grafts or refractive surgery complications.
Severe dry eye — the fluid reservoir keeps the ocular surface hydrated all day, which can be transformative for conditions like Sjögren's or graft-versus-host disease.

What is fitting and daily life like?

Because they are custom lenses, scleral fitting is a careful, iterative process — worth it for the result. Handling takes practice at first: they are applied with preservative-free saline such as Avizor unidose saline or Eyeye saline, using an insertion tool like the DMV Luma-Serter Plus or DMV Vented Scleral Cup, and removed with a small suction device such as the DMV Ultra or DMV 45. Most people become confident within a couple of weeks. Good hygiene and the correct scleral lens care routine are essential, and we teach all of this.

Talk to us

At Rose Optometry we specialise in scleral and rigid lens fitting, supported by the clinical focus of the New Zealand Eye Research Centre. If you have keratoconus or have been told you are “hard to fit,” a scleral lens assessment is well worth your time.

References

Barnett M, Courey C, Fadel D, et al. CLEAR — Scleral lenses. Cont Lens Anterior Eye. 2021;44(2):270–288.
Rathi VM, Mandathara PS, Dumpati S. Contact lens in keratoconus. Indian J Ophthalmol. 2013;61(8):410–415.

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