If you wear scleral lenses, the solution you use to fill them matters more than many patients realise.
Unlike a conventional contact lens, a scleral lens creates a reservoir of fluid between the back surface of the lens and the cornea. That fluid can remain against the eye for many hours.
For this reason, we generally recommend filling scleral lenses with a sterile, preservative-free saline intended for ocular use.
Why Preservative-Free Saline Matters
Some saline products are designed primarily for rinsing contact lenses, rather than for sitting underneath a scleral lens all day.
Preservatives and other ingredients that may be well tolerated during brief rinsing can be less comfortable when trapped beneath a scleral lens for an extended period.
Possible symptoms can include:
- stinging or burning after insertion
- redness
- irritation
- increasing discomfort during the day
- reduced lens wearing time
For patients with keratoconus, dry eye or an already sensitive ocular surface, choosing the filling solution carefully can make a noticeable difference.
What About Lens Plus OcuPure Saline?
This is an important distinction.
Lens Plus OcuPure is a sterile buffered isotonic saline commonly sold for contact lens rinsing. However, the manufacturer describes it as containing an OcuPure preservative system.
We have seen some scleral lens wearers who experience irritation or discomfort when using OcuPure saline as their lens-filling solution, even though they may tolerate it perfectly well for rinsing.
That does not mean OcuPure is a poor contact lens product. It means that rinsing a lens and filling a scleral lens reservoir are different uses.
For someone experiencing unexplained burning or irritation with their scleral lenses, we will often review the filling solution and consider changing to a true preservative-free, single-use saline.
Single-Use Saline Is Usually Our Preference
For scleral lens filling, we generally prefer sterile preservative-free saline supplied in individual ampoules or vials.
Single-use containers have several advantages:
- no preservative is required to keep a large multidose bottle stable after opening
- each new vial begins sterile
- there is less opportunity for the bottle tip or remaining solution to become contaminated
- it is easy to carry a fresh vial when away from home
Once a single-use ampoule has been opened, we recommend following the manufacturer’s instructions and generally avoiding keeping it for repeated use later.
Shop preservative-free saline for scleral lenses
Don’t Reuse Saline From the Lens
The saline removed from a scleral lens should never be saved and reused.
Once it has been in contact with the eye and lens, it is no longer sterile. Discard the old fluid, clean and disinfect the lens appropriately, and use fresh saline for the next insertion.
Saline Does Not Clean or Disinfect Your Scleral Lenses
Another common source of confusion is treating saline as an all-purpose lens solution.
Saline is primarily used for rinsing and filling. It does not replace an appropriate cleaning and disinfection system.
Depending on your particular lens and care routine, this may involve:
- a daily lens cleaner
- a hydrogen peroxide disinfection system
- additional periodic cleaning for deposits
If hydrogen peroxide is used, it must be fully neutralised according to the product instructions before the lens goes onto the eye.
The solution used to disinfect your lenses and the saline used to fill them serve different purposes.
Avoid Homemade Saline and Tap Water
Homemade saline should not be used to fill scleral lenses.
Even if the salt concentration appears correct, homemade solutions are not reliably sterile.
Tap water should also never be used to rinse, store or fill a scleral lens because water can contain microorganisms that are harmless when swallowed but potentially dangerous if introduced to the eye.
What If Preservative-Free Saline Still Stings?
Changing saline can help some patients, but the filling solution is not always the reason a scleral lens feels uncomfortable.
Persistent burning, redness, fogging or discomfort can also be associated with:
- lens fit
- excessive or insufficient clearance
- debris entering the fluid reservoir
- air bubbles beneath the lens
- ocular surface inflammation
- dry eye or meibomian gland dysfunction
- deposits on the lens surface
- sensitivity to cleaning-product residue
- inadequate rinsing after disinfection
If symptoms repeatedly occur shortly after inserting the lens, bring all of the solutions you currently use to your appointment. Sometimes the problem becomes much easier to identify once we review the entire lens-care routine.
Not Every Scleral Lens Wearer Needs the Same Saline
Some patients tolerate a wide variety of solutions without difficulty.
Others notice a substantial difference from changing to a different preservative-free saline.
Patients with significant dry eye, ocular surface disease, allergies or highly sensitive eyes may require a more individualised approach.
The important point is that persistent discomfort should not simply be accepted as part of wearing scleral lenses.
Scleral Lens Care at Westmead Eyes
At Westmead Eyes, we fit and manage scleral lenses for patients with conditions including:
- keratoconus
- irregular corneas
- previous corneal grafts
- significant corneal scarring
- complex contact lens requirements
- ocular surface disease
As part of scleral lens aftercare, we can review not only the lens fit but also your cleaning, disinfection and filling routine.
If your lenses sting when you insert them, become uncomfortable during the day or repeatedly fog, the solution you are using is one of several factors worth checking.