WEARING SCLERAL LENSES overnight is not a common practice, but it can be necessary for specific patients. Patients who have severe ocular surface disease have a few options for protecting their cornea overnight. Depending on the severity of the exposure and the health of the cornea, their treatment can range from ophthalmic ointment, eye mask or moisture chamber goggles, patching, taping their eye shut, soft bandage contact lens, and a scleral contact lens.
In patients who have severe ocular surface disease, the use of an “extended wear” overnight therapeutic scleral lens has many advantages. The ability to remove the lens, high-oxygen-permeable materials, significant corneal protection, and the presence of a pre-corneal fluid reservoir make a scleral lens appropriate for these situations.
Over the last 20 years, researchers have been looking at the hypoxic effect of extended rigid GP scleral contact lens (RGP ScCL) wear. In 2004, a study of 4 healthy eyes found that overnight wear of RGP ScCLs caused an increase in cornea swelling, measured by pachymetry, compared to overnight swelling without a lens, ranging from 4.9% to 17.5%. This swelling correlated strongly with endothelial cell density (Smith et al, 2004). Ultimately, the authors concluded that overnight therapeutic ScCL wear is an option for patients who have ocular sequelae that cannot be treated successfully with other therapeutic lens options (Smith et al, 2004).
In 2013, a retrospective interventional case series was published reviewing the clinical database of patients who have recurrent epithelial erosion due to severe ocular surface disease who underwent scleral lens wear over a span of 5 years (Lim et al, 2013). The conclusion was that using a regimen of daytime and overnight scleral lens wear helped promote healing in 17 of the 20 eyes treated. The use of a fourth-generation fluoroquinolone antibiotic drops in the bowl of the scleral lens resulted in healing of persistent epithelial defects and reduced the rate of microbial keratitis. Moxifloxacin was chosen because it gives broad spectrum coverage, high tissue penetration, and a preservative-free option to avoid epithelial toxicity. The cases described show scleral lenses being used as pharmaceutical reservoirs allowing for prolonged drug availability due to low fluid turnover.
In 2018, a case series was published on the overnight wear of scleral lens for persistent epithelial defects with patients wearing scleral lenses with moxifloxacin (He et al, 2018). The case report followed 3 cases and concluded that the daytime and overnight wear of scleral lenses, which included autologous serum use in 2 of the cases, provided healing in less time than previously reported for the treatment of refractory epithelial defects.
The recommendations from the literature for a daytime and nighttime treatment plan include removal of lenses for disinfection every 12 hours; applying a drop of moxifloxacin HCL 0.5% to the reservoir of the lens before reapplication; and topping off the reservoir with preservative-free saline solution. Additional recommendations that have been shared through different forums over the years have included having 2 sets of lenses (1 for daytime and 1 for nighttime wear) and to use the max Dk material possible.
When all other options are either unsuitable or less effective, the use of an overnight therapeutic scleral lens has many advantages and should be considered.
References
1. Smith GT, Mireskandari K, Pullum KW. Corneal Swelling with Overnight Wear of Scleral Contact Lenses. Cornea. 2004;23(1):29-34. doi: 10.1097/00003226-200401000-00005
2. Lim P, Ridges R, Jacobs DS, Rosenthal P. Treatment of persistent corneal epithelial defect with overnight wear of a prosthetic device for the ocular surface. Am J Ophthalmol. 2013;156(6):1095-1101. doi: 10.1016/j.ajo.2013.06.006
3. He X, Donaldson KE, Perez VL, Sotomayor P. Case Series: Overnight Wear of Scleral Lens for Persistent Epithelial Defects. Optom Vis Sci. 2018 Jan;95(1):70-75. doi: 10.1097/OPX.0000000000001162