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Contact Lens SpectrumRising Above the Surface

How to fit scleral lenses when a patient has systemic or ocular surface conditions.

The management of ocular surface disease (OSD) is a complex process, with scleral lenses playing a crucial role. This article delves into the intricacies of fitting scleral lenses, the impact of systemic diseases on the ocular surface, and the challenges and solutions in managing OSD.

Key Points:

  • Understanding ocular and scleral shapes, as well as the ocular surface environment and tear film, is essential when fitting scleral lenses.
  • Scleral lenses have demonstrated the ability to treat and rehabilitate compromised ocular surfaces, but they are not typically the first-line treatment.
  • A recent study on treatment for OSD surveyed 778 practitioners with scleral lens prescribing experience, finding that 45% of participants ranked scleral lenses as their sixth, seventh, or eighth treatment based on median overall rank.
  • Scleral lenses are recommended in the third or fourth stage of dry eye disease treatment according to the Tear Film & Ocular Surface Society’s Dry Eye Workshop II.
  • Systemic diseases can greatly influence the eye—its shape, structure, and tear film qualities.

Additional Points:

  • Sjögren’s, an autoimmune disorder affecting the exocrine glands, contributes to dry mouth and dry eyes. The disorder can exist independently or be associated with other autoimmune conditions.
  • Graft-versus-host disease (GVHD) is a complication of allogeneic hematopoietic stem cell transplantation (allo-HSCT) in which donor T cells view recipient antigens as an unknown threat and subsequently attack.
  • Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are life-threatening diseases characterized by skin detachment and blisters, with high mortality rates and both short-term and long-term morbidities.
  • Keratoconus is not a systemic disease, but is often associated with conditions such as Down syndrome, Leber’s congenital amaurosis, Ehlers-Danlos syndrome, Noonan syndrome, and mitral valve prolapse.
  • Many disorders, such as rheumatoid arthritis, osteoarthritis, psoriatic arthritis, gout, and systemic lupus erythematosus have joint involvement. These conditions may contribute to deformation in the extremities and limit mobility of the shoulders, arms, hands, and fingers.


  • The management of OSD is a complex process that requires a deep understanding of the ocular surface, scleral shapes, and the impact of systemic diseases. Scleral lenses play a crucial role in this process, but they are not typically the first-line treatment. As the patient’s disease changes, so will the ocular surface and the scleral lens fittings, designs, routine wear, and the daily care and maintenance involved.

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“Systemic diseases affect the entire body, and the eye, encased in mucus membranes, with a highly innervated cornea and the need for a healthy and robust tear film, is often one of the structures most impacted by systemic imbalance.”

Dr. Gloria Chiu
Associate Professor of Clinical Ophthalmology
USC Roski Eye Institute at the University of Southern California Keck School of Medicine
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