There are a number of situations in which it may be necessary for patients to wear their scleral lenses on an overnight/extended wear basis. The primary therapeutic reasons for the prolonged wearing schedule are to provide barrier support/protection, for persistent corneal erosions, and for lubrication to promote more rapid wound healing. The overnight wear of a scleral lens is most often temporary (until the underlying epithelial defect has fully healed); but, in some rare cases, an even longer continuous wearing schedule may be indicated.

In a poster at the 2016 Global Specialty Lens Symposium, Nefedov et al addressed the question “Do Scleral Lenses Provide Adequate Oxygen Permeability for Overnight Lens Wear?” Their results showed that the average amount of overnight corneal swelling while wearing scleral lenses was 10.3%, with a range of 7.5% to 14.1%, and overnight corneal swelling with no contact lens wear was 2.3%. These results appear to indicate that therapeutic, overnight wear of scleral lenses needs to be approached with a great deal of caution. While this is true, we have seen remarkable wound healing take place beneath scleral lenses when worn on an overnight wearing schedule (Figures 1 and 2).

Minimizing Complications

To help limit possible complications while wearing scleral lenses on an extended wearing schedule, we advise our patients to have two sets of their scleral lenses so that one set can be disinfected (in hydrogen peroxide) while the other set is being worn. We instruct our patients to comply with the following care regimen:

1. Remove your current lens(es) at night prior to going to bed, and clean the lens(es) in the palm of your hand with a daily contact lens cleaner. Thoroughly rinse the cleaner from the lens surface(s) with a sterile saline solution, and disinfect the lens(es) in hydrogen peroxide. Absolutely no tap water should be used throughout the cleaning, rinsing, or disinfection process.
2. Remove the second disinfected lens(es) from the case, and prepare the lens(es) for application. Place a drop of a preservative-free antibiotic (moxifloxacin) into the bowl of the lens(es) and completely fill the bowl with sterile, preservative-free saline.
3. Apply the lens(es) and go to sleep.
4. Upon awakening, remove the lens(es), and thoroughly rinse the eyes with a sterile, preservative-free saline solution (to remove any loose debris from the eyes); apply the previously disinfected contact lens(es) as described above.
5. Clean and disinfect the alternate contact lens(es) so that it (they) will be ready for application that evening.

This regimen can be modified to accommodate patients’ unique ocular condition and social circumstances. CLS

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