Pediatric and Teen CL Care

Application and Removal of Pediatric Scleral Lenses

BY MELANIE FROGOZO, OD, FAAO

There are some differences in the application and removal procedure for scleral contact lenses between adults and young children. This article focuses on the scleral contact lens application and removal process for toddlers and young children.

Toddlers

The challenge with toddlers is that they will rarely stay still during the application and removal of lenses. Thus, the most effective technique for toddlers is to place them into a supine position on the floor using your body to gently restrict their movement (Figure 1). Even though toddlers are unlikely to fully open their eyes, only a small opening is necessary to apply a scleral lens.

Figure 1. Gently restraining a toddler makes it easier to apply a scleral lens on the eye.

First, fill the lens with a viscous solution, such as a preservative-free artificial tear. Holding the scleral lens in your fingers, apply the lens by sliding it upward under the upper lid, followed by pulling the lower lid over the lens.

To remove the lens, secure the child in the same supine position and loosen the lens on the eye using lubricating drops or preservative-free saline. Open the toddler’s lids as wide as possible and use a small plunger to remove the lens. As only a small opening is necessary, don’t worry if the eye is not fully open.

Young Children (<6 Years)

Young children typically enjoy following instructions, so ask the child to stand with his head down while pulling open his lower lid.

To apply the lens, fill it with preservative-free saline or artificial tears, hold the upper lid open yourself, and apply the lens much like you would for an adult (Figure 2). If the child has trouble keeping his eyes wide open, revert to applying the lens like you would for a toddler—slide it under the upper lid and pull the lower lid over the lens.

Figure 2. Applying scleral lenses in young children is very similar to adults.

To remove the lens, ask the child to hold his head back; use one hand to open the lids and the other to remove the lens with a small plunger. As with a toddler, the lids do not have to be open all the way to remove the lens. However, if the child opens his lids wide, remove the lens as you would for an adult.

Typically, at about 6 years of age, children can remove scleral lenses on their own. At age 7, they can learn how to apply the lens themselves.

Scleral lenses have many therapeutic benefits, so don’t let a patient’s age get in the way of fitting them. CLS

Dr. Frogozo specializes in adult and pediatric specialty contact lenses. She is the director of the Contact Lens Institute of San Antonio and the owner of Alamo Eye Care in San Antonio, Texas. You can contact her at contactlensinstitutesa@gmail.com.