Quick answer. Scleral lenses are large-diameter (15–22 mm) rigid gas-permeable contact lenses that vault entirely over the cornea and rest on the white of the eye. The space between the back of the lens and the cornea is filled with preservative-free saline, which becomes a constant moisture reservoir that bathes the corneal surface throughout the day. Scleral lenses give clear vision in eyes that no other lens can — keratoconus, severe dry eye, post-LASIK ectasia, irregular astigmatism, post-corneal-transplant, high astigmatism, Sjögren’s syndrome, ocular surface disease from graft-versus-host disease, and many other conditions. At Vision Experts in Amman we fit scleral lenses in 4–6 visits across a 4–6 week period. Most patients reach 20/20 or near-20/20 acuity in the first month.
Reviewed by Bilal Rawashdeh, Optometrist & Contact Lens Specialist, founder of Vision Experts. 20+ years of specialty contact lens fitting experience. Last clinical review: 31 May 2026.
What scleral lenses are
A scleral lens is a rigid gas-permeable (RGP) contact lens with a diameter of approximately 15–22 millimetres. To put that in context, a normal corneal RGP is 9–10 mm and a normal soft contact lens is about 14 mm. The scleral lens is large enough that it extends beyond the cornea and lands on the conjunctival tissue covering the white of the eye (the sclera).
The key feature is the vault. The back surface of the lens is designed to clear the cornea entirely. There is space between the back of the lens and the front of the cornea — typically 200–400 microns at the centre. Before insertion, the patient fills the back of the lens with preservative-free saline. When the lens is inserted, that saline is trapped between the lens and the cornea, creating a fluid reservoir that bathes the corneal surface for the entire wearing day.
The optical surface of the scleral lens is rigid and regularly curved — like the front of a tiny window. Light comes through that regular surface, focuses correctly, and produces sharp vision. The irregular shape of the underlying cornea no longer matters optically because the lens replaces the cornea’s role as the eye’s primary optical surface.
Why this design solves what soft lenses and small RGP lenses cannot
Soft contact lenses drape over the corneal surface. If the cornea is irregular (keratoconus, post-LASIK ectasia, post-transplant), the soft lens drapes over the irregularity and the patient still sees the distorted image.
Small corneal RGP lenses sit directly on the cornea. They give excellent optics for mild irregularity but the lens edge sits on the corneal surface, which can cause apical scarring in keratoconus over years of wear, and they can be uncomfortable for first-time wearers.
Scleral lenses solve both problems simultaneously. The vault means nothing touches the sensitive cornea, so comfort is excellent — patients wear scleral lenses 12–14 hours per day routinely. The rigid optical surface means vision is excellent regardless of how irregular the underlying cornea is.
Conditions we fit scleral lenses for
The Scleral Lens Education Society maintains a published list of indications. At Vision Experts we routinely fit scleral lenses for all of the following:
1. Keratoconus (moderate-to-advanced)
The single largest indication. Approximately 60% of the scleral lens fittings at Vision Experts are for keratoconus patients who have outgrown smaller RGP lenses or who never tolerated them in the first place. See our keratoconus hub for the full clinical picture.
2. Severe dry eye disease
The saline reservoir under the lens provides constant corneal hydration. For patients with severe aqueous-deficient dry eye, evaporative dry eye that is resistant to topical therapy, or neurotrophic keratopathy, scleral lenses are often the only thing that gives all-day comfort. Many of these patients have been to multiple eye-care providers and tried every drop without relief — the scleral lens reservoir is qualitatively different from any topical.
3. Sjögren’s syndrome
Autoimmune destruction of the lacrimal glands causes the most severe form of dry eye. Sjögren’s patients are excellent candidates for scleral lenses precisely because their own tear production has failed and the lens provides the artificial reservoir their eye needs.
4. Post-LASIK ectasia
A small percentage of LASIK patients develop progressive corneal thinning and irregularity years after the surgery — post-refractive ectasia. The treatment is similar to keratoconus: cross-linking to halt progression, then specialty contact lenses (typically scleral) for visual rehabilitation. Vision Experts fits a steady stream of post-LASIK ectasia patients from across the region.
5. Post-corneal-transplant (PKP and DALK)
After penetrating keratoplasty or deep anterior lamellar keratoplasty, the grafted cornea is typically irregular and the patient cannot achieve good vision with glasses or standard contact lenses. Scleral lenses are the optical solution. Fitting is more demanding than non-grafted eyes and the scleral profile under the lens edge needs careful mapping to avoid pressing on suture lines or graft edges.
6. Irregular astigmatism (idiopathic or post-trauma)
Any cause of irregular astigmatism can be visually rehabilitated with a scleral lens. We see post-trauma cases (corneal laceration repair, chemical injury), pellucid marginal degeneration (a cousin of keratoconus where the cornea thins in the inferior periphery), and idiopathic high astigmatism.
7. Graft-versus-host disease (GvHD) ocular surface disease
Bone-marrow-transplant patients sometimes develop chronic GvHD that affects the ocular surface — severe dry eye, conjunctival scarring, keratitis. Scleral lenses provide both optical correction and a protective barrier for the damaged corneal surface.
8. Salzmann’s nodular degeneration and other ocular surface disorders
Various ocular surface conditions that produce corneal irregularity benefit from scleral lens correction.
9. High astigmatism (where regular contacts fail)
Some patients have astigmatism so high (above 4–5 diopters) that toric soft lenses do not give stable acuity. Scleral lenses with built-in toricity at the front and back surfaces give excellent stable vision.
10. Aniridia and post-surgical pupil anomalies
Patients with congenital aniridia or post-surgical pupil distortion benefit from scleral lenses with built-in iris designs that reduce glare and improve comfort in bright environments.
The fitting process at Vision Experts
Scleral lens fitting is the most technically demanding contact lens fitting in clinical optometry. The lens must vault the cornea correctly (not too tight against the corneal apex, not so loose that it pumps fluid in and out), land symmetrically on the conjunctiva (not impinge on the limbus or scleral vessels), and produce clear stable vision through the front optical surface.
At Vision Experts the standard protocol is:
Visit 1 — Diagnostic workup (90 minutes)
Full case history including the reason for referral, prior contact lens history, dry-eye symptoms, and lifestyle expectations. Then:
- Refraction — best-corrected visual acuity with current correction.
- Slit-lamp biomicroscopy — front-of-eye health, lid health, tear-film assessment, fluorescein staining if dry-eye signs are present.
- Scheimpflug tomography (TMS-5) — anterior and posterior corneal elevation, pachymetry, and elevation index. This is the lens-design input for both vault and centration calculations.
- Corneal topography — standard Placido-disc topography for confirmation.
- Discussion of options — soft toric, hybrid, RGP, and scleral are all explained with their fit, comfort, and visual-quality trade-offs. For most patients past the early disease stage, scleral is the recommendation.
- Cost estimate — written estimate with the all-in fitting band.
Patient leaves with a treatment plan and a fitting date.
Visit 2 — Trial lens fit (60 minutes)
Typically 2–4 weeks after Visit 1. We select a trial lens from our 60-parameter scleral fitting set based on the topography and a sagittal-depth calculation. The lens is inserted with preservative-free saline. We assess:
- Central vault over the cornea — measured by anterior segment OCT or by slit-lamp section. Target: 200–400 microns clearance at the apex.
- Limbal clearance — the lens should not touch the corneal limbus (the transition zone between cornea and sclera).
- Scleral landing zone — the lens edge should rest on the conjunctiva symmetrically, with no blanching of conjunctival vessels (a sign of too-tight fit).
- Over-refraction — refining the prescription with the trial lens in.
If the fit is acceptable we order the custom lens with the over-refraction built in. If the fit needs adjustment (which is common on the first trial) we re-fit at this visit and order based on the second iteration.
Visit 3 — Dispense + insertion training (60 minutes)
1–2 weeks after Visit 2 the custom lens arrives. We dispense it, verify the fit and acuity, and train the patient in:
- Insertion with a fluid-filled DMV plunger or finger technique
- Removal with a small suction-cup tool
- Cleaning with hydrogen peroxide system or multi-purpose solution
- Filling with preservative-free saline at insertion
- Mid-day fogging troubleshooting if it occurs
- Storage overnight in cleaning solution
Insertion training is the part patients are most anxious about. Most are insertion-capable by the end of the first session; some need a return practice visit. We do not send patients home without demonstrated competence at insertion and removal.
Visit 4 — One-week follow-up (30 minutes)
Quick check of wearing time, comfort, vision, and any signs of complication. We adjust parameters if anything is off. A fit that was perfect at dispense can occasionally need fine-tuning after the lens has been worn through a full day cycle.
Visit 5 — One-month follow-up (30 minutes)
Standard check at month one confirms long-term comfort. Almost all routine fits are stable at this point.
Visit 6+ — Three-month and beyond (30 minutes each)
Three-month follow-up is the standard final visit in the initial fitting cycle. After that we move to a six-month or annual cadence depending on the underlying condition.
Total timeline for a straightforward keratoconus or dry-eye fit: 4–6 weeks from Visit 1 to a stable settled lens. Complex post-graft, post-LASIK, or asymmetric cases: 8–12 weeks.
The equipment we use
Scleral lens fitting quality depends as much on diagnostic equipment as on clinical experience. Our standard scleral workup uses:
- Scheimpflug Tomographer TMS-5 — primary diagnostic device. Provides anterior elevation, posterior elevation, pachymetry, and elevation-index calculations needed for lens-design.
- NIDEK ARK-1 — autorefraction and keratometry.
- TOMEY non-contact tonometer — for intraocular pressure where indicated.
- Topcon slit-lamp biomicroscope — front-of-eye examination, lens fit assessment, photography.
- Scleral fitting set — approximately 60 trial lenses spanning the diameter, sagittal depth, and base curve combinations we routinely use.
For complex cases we collaborate with anterior segment OCT specialists to image the corneal-lens interface directly.
What scleral lens fitting feels like
The first lens insertion is the part patients fear most and the part that turns out to be easier than expected. The lens is large, but with proper technique it settles in place without any sensation of “something in the eye.” Once the lens is on, most patients describe the comfort as superior to small RGP lenses they may have tried previously.
Common patient observations:
- Comfort. The lens edge sits on conjunctiva, not on the corneal nerves. Most patients are unaware of the lens after the first hour.
- Vision. Sharp from the first minute. There is no adaptation period for clarity the way there can be with small RGP lenses.
- Wearing time. 12–14 hours per day is normal. Some patients wear 16 hours; we recommend a maximum daily wear of 14 hours to allow corneal oxygenation overnight.
- Mid-day fogging. Sometimes the fluid reservoir develops debris from tear-film proteins; vision becomes mildly hazy after several hours. Solution: remove the lens, rinse, refill with fresh saline, reinsert. Takes 90 seconds.
- The reservoir feeling. A small subset of patients are aware of a “wet feeling” behind the lens initially. This fades within the first week.
Daily care and maintenance
Scleral lens care is more involved than soft contact lens care because the lens must be cleaned thoroughly and the fluid reservoir refilled fresh every wear. The cardinal rule is: never insert a scleral lens without fresh preservative-free saline in the bowl.
Insertion routine
- Wash hands with non-perfumed soap. Dry on a lint-free cloth.
- Inspect the lens for chips, cracks, or surface deposits. If any are present, do not insert — call us.
- Rinse the lens with multi-purpose solution.
- Fill the bowl of the lens with preservative-free saline until it forms a slight dome above the rim.
- Bend forward, parallel to the table.
- Hold the upper and lower lids open with the non-dominant hand. Insert the lens with the dominant hand. The lens should make contact with the eye centrally with no air bubble underneath.
- If a bubble is trapped under the lens, remove the lens and re-insert with more saline.
Removal routine
- Use a small DMV-style suction cup tool to lift the lens off the eye.
- Catch the lens in the palm of the hand.
- Rinse with multi-purpose solution.
- Clean with hydrogen peroxide cleaning system (preferred) or multi-purpose solution.
- Store in fresh cleaning solution in the lens case.
Cleaning protocols
- Daily cleaning: rinse + clean + store at the end of every wear.
- Weekly deep clean: use a protein-removal cleaner or extended hydrogen peroxide soak.
- Solution replacement: never top up the case — empty, rinse, refill with fresh solution every storage.
- Case replacement: every 3 months.
- Annual lens inspection at Vision Experts.
What can go wrong (honest list)
Scleral lenses are safe when properly fit and cared for, but they are medical devices and complications occur. The main ones:
- Microbial keratitis. Any contact lens worn for extended hours can cause corneal infection. Modern Ortho-K hygiene protocols and the rigid material of scleral lenses make this rare — incidence is roughly 1 in 7,700 wear-years, comparable to extended-wear soft contact lenses. Symptoms: increasing eye pain through the wearing day, redness that does not clear, light sensitivity that is new. Stop wearing the lens and contact us immediately.
- Conjunctival impingement. A scleral lens that is too large or too steep can press on conjunctival vessels and cause a “vessel-impingement ring” — visible blanching of vessels under the lens edge. Treatment: re-fit with a different lens parameter.
- Mid-day fogging. Debris in the fluid reservoir clouds vision through the day. Solution: remove, rinse, refill with fresh saline, reinsert. If frequent, we may switch to a different reservoir fluid.
- Corneal hypoxia. Inadequate oxygen reaching the cornea under a too-tight lens. Symptoms: corneal edema, blur on lens removal. Treatment: re-fit with a higher-Dk lens material or wider fitting.
- Lens loss. Scleral lenses sometimes pop out unexpectedly (rare but possible). Patients are taught how to find a dislodged lens, rinse it, and reinsert.
- Allergic conjunctivitis. Patients with preservative sensitivity may react to the saline preservatives. Solution: switch to preservative-free.
Our complication rate over the past several years has been consistent with the published literature. We track every adverse event and audit our protocols annually.
Travel and lifestyle
- Travel. Pack twice as much saline and cleaning solution as you think you need. Carry the lens case in your carry-on, not checked luggage.
- Swimming. Scleral lenses cannot be worn in pool or sea water — the fluid exchange between water and reservoir is a contamination risk.
- Sport. Most sport is fine in scleral lenses. For high-impact contact sports, sport goggles over the lenses give an extra layer of protection.
- Dust and outdoor environments. The sealed reservoir under the lens actually protects the cornea from environmental irritants better than glasses or soft lenses do.
- Computer work. The reservoir keeps the cornea hydrated during long screen sessions where the blink rate drops. Scleral lens wearers often report less computer-related dry eye than soft-lens wearers.
Frequently asked questions
How long do scleral lenses last?
Typically 18–24 months of daily wear before replacement is needed. Some patients get 30 months from a pair; others need replacement at 12 months due to scratch damage or surface protein deposit accumulation.
Can scleral lenses be worn overnight?
No. Scleral lenses are daily-wear only. The microbial keratitis risk is significantly higher with overnight wear and we do not fit scleral lenses for sleep wear.
How does the saline get under the lens?
You fill the lens bowl with preservative-free saline before insertion. The fluid is trapped between the back of the lens and the front of the cornea by the seal at the scleral landing zone. It remains there for the entire wear, refreshing itself through tiny exchanges through the seal.
Can I swim with scleral lenses?
No. Swimming risks contamination of the fluid reservoir with pool or sea-water bacteria, and the lens may also dislodge.
Do scleral lenses fog up?
Mid-day fogging occurs in a subset of patients — the reservoir accumulates protein debris from the tears and vision becomes mildly hazy after several hours. The solution is to remove the lens, rinse it, refill the bowl with fresh saline, and reinsert. The whole process takes 90 seconds. Some patients add this routine to their lunch break.
Are scleral lenses uncomfortable?
Most patients find scleral lenses more comfortable than smaller RGP lenses. The lens edge sits on the conjunctiva (the white of the eye), not on the corneal nerves, so there is no surface-irritation sensation that small RGPs sometimes produce.
How much do scleral lenses cost?
Scleral lens fitting fees depend on case complexity. We provide a written estimate after the diagnostic workup. Please contact us for a personalised quote.
Does insurance cover scleral lenses?
Most Jordanian private health insurance carriers cover specialty contact lens fitting for documented medical indications — keratoconus, post-graft eyes, severe dry eye in Sjögren’s, post-LASIK ectasia. The exact coverage varies. We provide itemized invoices and the clinical documentation insurance requires.
Can I drive after my first scleral lens fitting?
Yes, generally. The first insertion produces immediate clarity in most cases. Patients drive home after Visit 3 (the dispense visit). The only restriction is that we ask first-time wearers not to drive at night until they have worn the lenses through several day cycles, so they have full confidence in their vision and the comfort.
How long does the fitting process take?
4–6 weeks for an uncomplicated case (Visits 1-5 spread across that window). 8–12 weeks for complex post-graft, post-LASIK, or asymmetric cases.
Will scleral lenses cure my keratoconus?
No. Scleral lenses correct vision but do not cure the underlying corneal disease. Keratoconus is non-curable but its visual consequences are correctable. See our keratoconus hub for the full picture on disease management.
What if my eye changes shape?
Corneal shape can change in active keratoconus (especially before stabilization or after cross-linking). We see scleral lens patients annually and re-measure the corneal topography. If the shape has changed significantly, we re-fit. The original lens design is on file so re-fits are typically efficient.
How do I clean scleral lenses?
Daily: rinse with multi-purpose solution, clean with a hydrogen peroxide system or multi-purpose, store in fresh solution. Weekly: protein-removal cleaner or extended peroxide soak. Always preservative-free saline for the bowl at insertion. Never sleep in the lenses. Replace the case every 3 months.
Can children wear scleral lenses?
Yes, in selected cases. Paediatric keratoconus, post-graft children, and severe paediatric dry eye are all indications. The child needs parental supervision for insertion and removal until they are demonstrably capable of self-handling — typically age 10-12.
What is the success rate?
The fitting success rate at experienced scleral lens centres is approximately 85-95% — meaning the patient ends up with a wearable, comfortable lens that gives functional vision. Reasons for fitting failure include severe corneal scarring (transplant referral), atypical scleral anatomy that no lens fits, or patient inability to handle insertion. At Vision Experts we have a similar success rate consistent with the published literature.
Related conditions and treatments
- Keratoconus management — the primary indication for scleral lenses
- All contact lens options — daily, monthly, RGP, hybrid, toric, multifocal, Ortho-K
- Ortho-K (Corneal Reshaping) — overnight contact lenses for myopia correction
- Comprehensive eye exam — required diagnostic workup
- About Vision Experts and Bilal Rawashdeh
- Blog: Keratoconus Treatment in Jordan 2026
Book a scleral lens consultation
If you are exploring scleral lenses for keratoconus, severe dry eye, post-LASIK ectasia, post-graft vision rehabilitation, or any irregular corneal condition — the first step is a diagnostic workup with corneal tomography. The exam takes about 90 minutes and is the basis for every fitting decision afterward.
Book online at /appointments/, email info@visionexperts.net, call +962 6 566 6122, or WhatsApp +962 77 566 6122.
We see patients from across Jordan and from neighbouring countries. International patients (GCC, Iraq, Syria, Egypt) make up a meaningful fraction of our scleral lens fittings — we coordinate diagnostic and dispense visits to minimize trips.
Author and medical reviewer. Bilal Rawashdeh, Optometrist & Contact Lens Specialist, founder of Vision Experts in Amman, Jordan. 20+ years of clinical experience fitting specialty contact lenses including scleral, RGP, hybrid, custom soft toric, and Ortho-K. Page clinically reviewed 31 May 2026 and updated as protocols evolve. For general information; not a substitute for in-person clinical assessment.
References. Scleral Lens Education Society. Fitting Consensus and Patient Care Guidelines. sclerallens.org. — Cleveland Clinic. Scleral Contact Lenses. clevelandclinic.org. — BostonSight PROSE Treatment information. bostonsight.org. — Walker MK et al. (2016). Complications and fitting challenges associated with scleral contact lenses. Cont Lens Anterior Eye. PMID 26603938. — American Academy of Ophthalmology Preferred Practice Pattern, Corneal Ectasia. aao.org.