OCULAR SURFACE DISEASE and inflammatory dry eye are common in patients of all age groups and can significantly affect a patient’s overall daily functioning and quality of life.¹ Daily activities such as reading, working on the computer, or even being outdoors can be debilitating due to persistent pain, photophobia, fluctuating vision, or foreign body sensation, which often accompany dry eye disease.¹ These patients have often tried numerous conventional therapies such as over the counter and prescription eye drops, punctal plugs, and even autologous serum drops with little to no relief in their symptoms and clinical signs.²

In recent years, scleral lenses have emerged as a powerful tool to manage not only these patients’ symptoms of dryness, but also to correct their vision to a level that is often not possible with spectacles and soft contact lenses.^2,3 The chamber created between the lens and the eye forms a fluid reservoir that provides consistent hydration and mechanical protection from the outside environment while also correcting the patient’s refractive error.³

This article will examine the indications, clinical evidence, and practical considerations for managing severe ocular surface disease and inflammatory dry eye using scleral lenses, and offer guidance to practitioners who seek to expand their therapeutic options.

Background and Pathophysiology

Dry Eye Disease: Dry eye disease is defined by the Tear Film & Ocular Surface Society Dry Eye Workshop II (TFOS DEWS II) report as “a multifactorial disease of the ocular surface characterized by a loss of homeostasis of the tear film, and accompanied by ocular symptoms, in which tear film instability and hyperosmolarity, ocular surface inflammation and damage, and neurosensory abnormalities play etiologic roles.”⁴ Dry eye disease affects millions of patients worldwide and can significantly affect a patient’s quality of life and daily functioning.^1-3

Until recently, dry eye disease was often subdivided into 2 distinct categories: evaporative and aqueous deficient dry eye. The DEWS III report, published in late 2025, expanded on the previously published DEWS I and II frameworks to provide a more comprehensive approach to dry eye care and to officially recognize dry eye as a symptomatic disease.¹

One key aim of that report is to adopt an approach to dry eye management that focuses on disease etiology by recognizing the drivers of the disease and managing it accordingly.¹ Factors such as tear film instability, tear film hyperosmolarity, inflammation, neurosensory abnormalities, and damage to the ocular surface must all be considered when creating a treatment plan for a given patient.¹

Inflammatory Ocular Surface Disorders: In addition to dry eye disease, a variety of inflammatory conditions can dramatically compromise a patient’s tear film and ocular surface.⁵ Autoimmune conditions like graft-versus-host disease (GVHD) (Figure 1) and ocular cicatricial pemphigoid (OCP) can induce chronic ocular surface inflammation, which can lead to corneal and conjunctival scarring and breakdown of the ocular surface.⁶ Acute onset inflammatory conditions such as Stevens-Johnson syndrome (SJS) can cause extensive epithelial compromise and severe dry eye⁷ (Figure 2). Neurotrophic keratitis stemming from herpetic infections, traumatic insults such as chemical burns, or even ocular surgeries can severely disrupt a patient’s ocular surface⁸ (Figure 3). As a result, these patients often suffer from significant ocular surface compromise, marked by persistent breakdown of the corneal epithelium, corneal scarring, and vascularization of the cornea.⁸

Therapeutic Rationale for Scleral Lenses

A scleral lens is a large-diameter rigid GP ocular device that rests on the patient’s bulbar conjunctiva and sclera and vaults the cornea, creating a fluid-filled chamber between the lens and the patient’s eye.^2,3,5 This fluid chamber helps correct corneal irregularities often seen in patients who have corneal ectasias such as keratoconus, and serves as a successful alternative when spectacles and soft contact lenses fall short.^2,3,5 Even though one of the primary applications for scleral lenses in modern contact lens practice is for the management of irregular corneas, an increasing number of ocular surface disease patients are turning to scleral lenses to provide relief for their symptoms when other therapies have failed.⁵

By submerging the patient’s cornea in fluid, the lens not only hydrates the eye throughout the duration of lens wear, it also serves as a physical barrier to protect the eye from the outside environment and promote healing of the ocular surface.⁹

Throughout the course of scleral lens wear, dry eye patients often experience relief from many of their symptoms, such as pain, photophobia, and ocular irritation.^2,3,5,8 In addition to relieving many of the patient’s symptoms, scleral lenses also provide customized correction that can sometimes surpass the visual acuity that can be achieved with spectacles and soft contact lenses.^2,3,5,8

Most scleral lens designs allow for complete customization to address both the patient’s vision and the fit of the lens.⁵ Lens design features such as toric and multifocal optics, quadrant-specific haptics, differential sagittal depth options, and edge alterations make it possible to fit highly asymmetric and uniquely shaped anterior segments.^10,11

Indications and Evidence

Scleral lenses have become an important tool for practitioners to manage symptoms in patients who have severe ocular surface disease, particularly when conventional topical therapy fails.^2,3,5 Although scleral lenses have brought relief in the form of visual rehabilitation to many patients who have irregular corneas and unique visual needs, a growing body of clinical evidence suggests that they are a viable option for a broad range of ocular surface conditions, especially when traditional therapies are ineffective.^2,3,5

Aqueous-Deficient Dry Eye: Among the many indications for scleral lenses in cases of ocular surface disease, conditions that cause reduced tear production are one of the most compelling.^3,5 Diseases like Sjögren syndrome cause the autoimmune destruction of the lacrimal gland and other secretory organs in the body.^9,12 Damage to these glands can cause severe lacrimal hyposecretion, resulting in discomfort that can be debilitating for the patient.^9,12 These patients have often failed to get relief from multiple aggressive first-line dry eye therapies such as preservative-free artificial tears, punctal occlusion, and topical inflammatory mediators like cyclosporine.^9,12

Multiple studies have shown that scleral lens wear significantly reduces symptom severity in Sjögren patients, with improvements in clinical findings such as corneal staining, Ocular Surface Disease Index (OSDI) scores, and self-reported quality of life.^9,13 In a study published in 2022, 43 patients fit with scleral lenses completed the OSDI survey before and after treatment.¹³ Following treatment with scleral lenses, the patients showed an average 54.7%±27.6% improvement in their dry eye symptoms based on their OSDI responses.¹³

Another study showed that commercially available scleral lenses can be successfully used to manage moderate to severe ocular surface disease.¹⁴ In this study, 115 patients were fit into scleral lenses and all but 2 of them reported improved comfort and showed improvement in their ocular surface disease signs.¹⁴

In addition to their role in managing symptoms of Sjögren disease, scleral lenses have shown promise in the management of other forms of aqueous-deficient dry eye, including age-related lacrimal dysfunction, dry eye following radiation therapy, and lacrimal gland dysfunction associated with systemic disease.⁵ In these cases, the tear reservoir serves as a replacement for the tear film that is absent as a result of the patient’s condition.^2,3,5 The tear fluid reservoir provides them with consistent symptom relief and ocular surface protection for the duration of lens wear.^2,3,5

Evaporative Dry Eye: Even though evaporative dry eye is most commonly associated with meibomian gland dysfunction, scleral lenses can play a vital role in the management of these patients, even after lid hygiene and meibomian gland function have been optimized.^2,3,5 Scleral lenses help relieve the symptoms associated with premature tear film evaporation by creating a sealed fluid chamber between the lens and the eye.^2,3,5

Patients who suffer from evaporative dry eye often experience significant visual fluctuations, as well as pain and photophobia, as a result of their unstable tear film.^3,15 While scleral lenses do not alleviate the root cause of these patients’ symptoms, they can provide stable vision and ocular comfort by creating a physical barrier between the patient’s eye and the outside environment.³ The comfort of these lenses can be further improved with the addition of hydrophilic coatings that increase lens surface lubricity and moisture retention.¹⁶

The use of scleral lenses in cases of evaporative dry eye is often an adjunctive therapy to the patient’s preexisting therapeutic regimen, but they can provide significant symptom relief for patients whose symptoms remain refractory to treatments like heat therapy and intense pulsed light.³

Autoimmune and Inflammatory Disorders: Scleral lenses also can play a significant role in the management of dry eye secondary to chronic autoimmune inflammatory conditions.^6,7 Conditions such as ocular GVHD, SJS, Wegener’s granulomatosis (Figure 4), and OCP can have profound effects on the ocular surface and lead to persistent epithelial compromise.^1,6,7

Patients who have ocular GVHD can be extremely challenging to manage and often describe constant pain and photophobia.⁶ Traditional topical therapies generally do not offer significant symptom relief,⁶ making compliance difficult. Scleral lenses provide these patients with not only consistent hydration but also protection of the ocular surface, which offers significant symptom relief and reduces the likelihood of epithelial damage.⁶

In patients who have SJS, scleral lenses serve as a barrier between the ocular surface friction caused by misdirected lashes and keratinized lid margins.⁷ These devices not only improve comfort by providing mechanical protection, but also serve to protect the ocular surface from progressive damage that would be much more likely if these devices were not in place.⁷

In cases of OCP, the conjunctiva becomes inflamed and scars.¹⁷ This causes shortening of the fornix and keratinization of the conjunctival tissue, which ultimately results in malpositioning of the eyelid.¹⁷ This contributes to the severe dryness and epithelial compromise that is often observed in these cases.¹⁷ Scleral lenses reduce mechanical trauma to the exposed area and provide a protected environment to promote healing of the ocular surface.¹⁷

Patients who have autoimmune and cicatricial disease can benefit greatly from the addition of scleral lenses to their treatment regimen, because they offer a level of protection to the ocular surface that other therapies are unable to provide.^6,7,17

Neurotrophic Keratopathies: Patients who have neurotrophic keratitis often have persistent or poorly healing epithelial defects that can cause severe corneal compromise if not managed effectively⁸ (Figure 5). Impaired corneal sensation from conditions such as diabetes, herpetic infections,¹⁸ or trigeminal nerve injuries disrupts the feedback loop between the eye and the brain, resulting in impaired wound healing.⁸ Scleral lenses provide consistent epithelial protection during the course of lens wear, allowing the cornea to heal without the threat of recurrent or worsening injury to the ocular surface.⁸ Recent case studies show that scleral lenses can promote epithelial healing in cases where aggressive lubrication, bandage contact lenses, and even amniotic membranes have been unsuccessful.^19,20 Although they are not traditionally a first-line therapy for neurotrophic keratitis, scleral lenses have emerged as a novel alternative when other therapies either fail or are not feasible.¹⁸

Post Surgery and Trauma: Patients who have a history of corneal transplantation, refractive surgery, or ocular trauma often develop dry eye following their injuries.^2,21,22 Patients who have undergone laser-assisted in situ keratomileusis (LASIK) or photorefractive keratectomy (PRK) often develop dry eye in the months or years following the procedure.²¹ Although some patients never report symptoms, other patients find the postoperative dryness associated with laser refractive surgery to be detrimental to their overall quality of life.²¹ Scleral lenses can provide these patients with relief from their dry eye symptoms and stable vision throughout the course of daily lens wear.^2,3,5

Patients are often left with irregular astigmatism and ocular surface concerns following a penetrating or lamellar keratoplasty.^2,3,22 Scleral lenses can not only provide these patients with clear and stable vision but also can protect the transplanted tissue and reduce the need for frequent ocular lubrication^2,22 (Figure 6).

In cases of mechanical or chemical trauma, the patient is often left with corneal irregularity, scarring, and in some cases ocular surface disease.^23,24 Scleral lenses help rehabilitate the patient’s vision by normalizing the anterior corneal surface, and they can also provide a controlled environment to help the patient’s eye to heal following their injury.²

Scleral lenses have a versatile range of applications for many different types of dry eye, ranging from inflammatory to traumatic.^2,3,14 Although they are not typically a first-line therapy, scleral lenses have been shown to improve patient comfort, improve clinical issues such as corneal staining, and provide a safe environment for compromised eyes to thrive regardless of the etiology of the dry eye.^9,13,14

Fitting Considerations

Although different from fitting a patient who has an irregular cornea, fitting scleral lenses for ocular surface disease still requires an individualized approach to the fitting process to achieve a successful end result for the patient.²⁵ Patients often present with a compromised ocular surface and chronic inflammation, which can make it more challenging to achieve a stable fit.⁹ Careful initial evaluation, lens selection, and thorough patient education are vital for success when fitting an ocular surface disease patient with scleral lenses.⁵

Initial Evaluation: A careful prefitting assessment is crucial for success when fitting all patients with scleral lenses, regardless of their underlying condition.^2,14 For patients who have ocular surface disease and inflammatory conditions, the prefitting assessment should include corneal evaluation, conjunctival assessment, eyelid examination, and assessment of the tear film.^3,25 When assessing the cornea, staining patterns, epithelial defects, neovascularization, and areas of corneal thinning should all be documented.^2,3,5 During conjunctival assessment, it is important to evaluate for symblepharon, keratinization, fornix changes, and other irregularities that may interfere with haptic alignment and lens centration.^3,5 Eyelid evaluation should include assessment of the meibomian glands and lashes as well as lid position, as these can influence comfort and lens tolerance.^3,5 Finally, a thorough tear film assessment should include evaluation of tear film stability and the presence of debris and filaments, as these can contribute to midday fogging during lens wear.^3,5

Lens Selection: The first parameter that is usually chosen when fitting a scleral lens is the overall diameter.^5,10 Patients who have ocular surface disease are often fit into larger-diameter lenses to cover more of the ocular surface and provide a greater therapeutic effect.^5,10 However, patients who have smaller palpebral apertures or dexterity issues may experience difficulty with lens handling and application, and a smaller-diameter lens may be necessary.^3,26

For patients who have ocular surface disease, it is important to be mindful of lens central clearance to avoid touching the cornea.^5,10,25 However, excessive clearance between the lens and the eye may cause corneal hypoxia.²⁷ A vault of between 200 and 300 µm after settling is desirable, although the amount of lens settling after application must also be considered.^10,25 One study found that scleral lenses settle approximately 100 µm over the course of daily wear, and the majority of that settling was greatest in the first 4 hours of lens wear, so this must also be considered throughout the fitting process.²⁸

Haptic alignment is another important aspect of scleral lens fitting in ocular surface disease patients that can profoundly affect a patient’s success with their lenses.¹⁰ Lenses with toric haptics have become the standard of care in modern scleral lens fitting, as they help align the landing zone of the lens with the steep and flat meridians of the patient’s eye for a potentially more comfortable fit.²⁹ Notches and focal vaulted areas of the landing zone can be used to avoid filtering blebs, pingueculae, or irregular areas of the conjunctiva.³⁰ For more irregular anterior segments, quadrant-specific and custom molded scleral lenses can be used to accommodate highly irregular anterior segment shapes.³⁰

Lens filling solution must also be considered when making recommendations for ocular surface disease patients.³¹ The standard of care for scleral lens filling is nonpreserved saline, but patients who have significant ocular surface disease may require other options to achieve optimal comfort from their lenses.³² Viscous solutions such as nonpreserved artificial tears may be used in cases of extreme dryness or persistent midday fogging.³¹ Autologous serum tears may also be used in cases of persistent epithelial defects to facilitate healing.³³ Additionally, thorough patient education is vital for success.^10,25

Challenges and Limitations

Although scleral lenses are a powerful therapeutic tool that can improve the quality of life for patients with severe ocular surface disease, they are not without their challenges.^32,34 Patients who have significant anterior segment scarring and irregularity may be extremely challenging to fit due to the unique shape of their eyes.^34,35 As a result, some patients may require lenses designed using corneoscleral profilometry or custom molded lenses to achieve a successful fit.^34,35 Additionally, lens handling can be difficult for patients who have poor dexterity, advanced age, arthritis, or poor uncorrected vision.³⁶ Therapeutic scleral lenses can also be expensive, and insurance coverage for these devices is not guaranteed despite the significant benefits they provide.³⁷ Out-of-pocket cost is often a major barrier to obtaining care when insurance coverage is not an option.³⁷

Implications for Clinical Practice

The pathologies, fitting considerations, and challenges listed above highlight the importance of a thoughtful approach to scleral lens fitting for patients who have dry eye disease and ocular surface inflammation. Careful patient selection, thorough evaluation of the ocular surface, consideration of the patient’s condition, and setting realistic expectations are crucial for long-term patient success when prescribing scleral lenses.²⁵ When fit properly, these patients’ symptoms can often be reduced and their quality of life can improve dramatically.^9,13

Scleral lenses are a powerful tool for the management of moderate to severe dry eye and ocular surface inflammation. These lenses provide the eye with continuous hydration, mechanical protection, and improved vision compared to other therapeutic alternatives.^2,3,5 They offer significant relief for patients who have used traditional therapies with minimal or no relief. Despite limitations such as cost and complexity, scleral lenses remain an effective tool for advanced ocular surface disease care.³⁴ With careful patient selection and detail-oriented lens fitting, as well as management of concurrent lid disease and inflammation, clinicians can provide excellent outcomes for their patients that significantly improve their quality of life.²⁵ As our body of clinical evidence continues to grow, the therapeutic role of scleral lenses in the management of dry eye and ocular surface inflammatory conditions will continue to grow.

References

1. Jones L, Craig JP, Markoulli M, et al. TFOS DEWS III: management and therapy. Am J Ophthalmol. 2025;279:289-386. doi: 10.1016/j.ajo.2025.05.039

2. Sah R, Sharma N, Priyadarshini K, Titiyal JS. Contact lenses for the treatment of ocular surface diseases. Indian J Ophthalmol. 2023;71:1135-1141. doi: 10.4103/IJO.IJO_17_23

3. Chaudhary S, Ghimire D, Basu S, Agrawal V, Jacobs DS, Shanbhag SS. Contact lenses in dry eye disease and associated ocular surface disorders. Indian J Ophthalmol. 2023;71:1142-1153. doi: 10.4103/IJO.IJO_2778_22

4. Craig JP, Nichols KK, Akpek EK, et al. TFOS DEWS II definition and classification report. Ocul Surf. 2017 Jul;15:276-283. doi: 10.1016/j.jtos.2017.05.008

5. Qiu SX, Fadel D, Hui A. Scleral lenses for managing dry eye disease in the absence of corneal irregularities: what is the current evidence? J Clin Med. 2024;13:3838. doi: 10.3390/jcm13133838

6. Cheng X, Huang R, Huang S, et al. Recent advances in ocular graft-versus-host disease. Front Immunol. 2023;14:1092108. doi: 10.3389/fimmu.2023.1092108 7. Tóth G, Lukács A, Schirra F, et al. Ophthalmic aspects of stevens–johnson syndrome and toxic epidermal necrolysis: a narrative review. Ophthalmol Ther. 2023;12:1795-1811. doi: 10.1007/s40123-023-00725-w

8. Witsberger E, Schornack M. Scleral lens use in neurotrophic keratopathy: A review of current concepts and practice. Eye Contact Lens. 2021;47:144-148. doi: 10.1097/ICL.0000000000000748

9. Nunziata S, Petrini D, Dell’Anno S, Barone V, Coassin M, di Zazzo A. Customized Scleral Lenses: An Alternative Tool for Severe Dry Eye Disease—A Case Series. J Clin Med. 2023 Jul;13:3935. doi: 10.3390/jcm13133935

10. van der Worp, E. A Guide to Scleral Lens Fitting (2nd ed.). Forest Grove, 2015. commons.pacificu.edu/mono/10 .

11. Macedo-De-araújo RJ, Fadel D, Barnett M. How can we best measure the performance of scleral lenses? Current insights. Clin Optom (Auckl). 2022;7:47-65. doi: 10.2147/OPTO.S284632 12. Wu KY, Chen WT, Chu-Bédard YK, Patel G,  Tran SD. Management of Sjogren’s dry eye disease—advances in ocular drug delivery offering a new hope. Pharmaceutics. 2022;15:147. doi: 10.3390/pharmaceutics15010147

13. Asghari B, Brocks D, Carrasquillo KG, Crowley E. OSDI outcomes based on patient demographic and wear patterns in prosthetic replacement of the ocular surface ecosystem. Clin Optom (Auckl). 2022;14:1-12. doi: 10.2147/OPTO.S337920

14. Schornack MM, Pyle J,  Patel SV. Scleral Lenses in the management of ocular surface disease. Ophthalmology. 2014;121:1398-1405. doi: 10.1016/j.ophtha.2014.01.028

15. García-Marqués JV, Macedo-De-Araújo RJ, Cerviño A, García-Lázaro S, González-Méijome JM. Assessment of meibomian gland drop-out and visibility through a new quantitative method in scleral lens wearers: A one-year follow-up study. Cont Lens Anterior Eye. 2023;46:101571. doi: 10.1016/j.clae.2021.101571

16. Mickles C, Harthan J, Barnett M. Assessment of a Novel Lens Surface Treatment for Scleral Lens Wearers with Dry Eye. Eye Contact Lens. 2021;47:308-313. doi: 10.1097/ICL.0000000000000754

17. Schornack M, Baratz K. Ocular Cicatricial Pemphigoid: the role of scleral lenses in disease management. Cornea. 2009;28:1170-1172. doi: 10.1097/ICO.0b013e318199fa56

18. NaPier E, Camacho M, McDevitt TF, Sweeney AR. Neurotrophic keratopathy: current challenges and future prospects. Ann Med. 2022;54:666-673. doi: 10.1080/07853890.2022.2045035

19. Grey F, Carley F, Biswas S, Tromans C. Scleral contact lens management of bilateral exposure and neurotrophic keratopathy. Cont Lens Anterior Eye. 2012;35:288-291. doi: 10.1016/j.clae.2012.07.009 20. Gelles J, Bekerman V, Greenstein S, Shafiq M, Hersh P. Descemetocele management with therapeutic scleral lens wear. Eye Contact Lens. 2021;47:314-316. doi: 10.1097/ICL.0000000000000765

21. Dossari SK. Post-refractive surgery dry eye: A systematic review exploring pathophysiology, risk factors, and novel management strategies. Cureus. 2024;16:e61004. doi: 10.7759/cureus.61004

22. Lekhanont K, Sukvaree P, Cheewaruangroj N, Vongthongsri P, Phimpho P, Pisitpayat P. Prevalence of dry eye disease and ocular surface abnormalities in eyes with corneal transplantation: A cross-sectional study. Clin Ophthalmol. 2025;19:3919-3932. doi: 10.2147/OPTH.S553614

23. Özçelik O, Özbek Z, Yıldırım CA, Durak İ. Spectrum of scleral lens fit and patient compliance: A single center retrospective study. Turkish J Ophthalmol. 2025;55:18-192. doi: 10.4274/tjo.galenos.2025.23238

24. Subramanian, M. Role of optic zone diameter in scleral lens fitting in traumatic aniridia with scarred cornea – A case report. Latin Am J Ophthalmol. 2024;7:15. doi:10.25259/LAJO_25_2024

25. DeNaeyer GW, Jedlicka J, Schornack MM. Scleral lenses. In Bennett ES, Henry VA. Clinical Manual of Contact Lenses (5th ed). Wolters Kluwer, Philadelphia, 2020:685-731:685-731

26. Kim H, Park TY, Joo CK. Mini-scleral contact lens for asian eyes post-penetrating keratoplasty with smaller palpebral aperture: Case reports. Clin Optom (Auckl). 2021;13:161-166. doi: 10.2147/OPTO.S295238

27. Giasson C, Morency J, Melillo M, Michaud L. Oxygen tension beneath scleral lenses of different clearances. Optom Vis Sci. 2017 ;94:466-475. doi: 10.1097/OPX.0000000000001038

28. Kauffman M, Gilmartin C, Bennett E, Bassi CA. A comparison of the short-term settling of three scleral lens designs. Optom Vi Sci. 2014;91:1462-1466. doi: 10.1097/OPX.0000000000000409

29. Alexander J, Belaineh Aweke Y, Bhebhe Z, Cho D, Lay S, Ryan I, et al. The effect of landing zone toricity on scleral lens fitting characteristics and optics. Ophthalmic Physiol Opt.  2024;44:867-875. doi: 10.1111/opo.13324

30. Gindina S, Kang J, Jacobs D. Scleral lenses for correction of irregular astigmatism: advances and limitations. Curr Opin Ophthalmol. 2025;36:282-287. doi: 10.1097/ICU.0000000000001149

31. Vurgun EB, Ozkan G, Turhan SA, Toker AE. The effect of scleral lens reservoir solution on post-lens fluid turbidity and settling in patients with keratoconus. Eye Contact Lens. 2025;51:529-535. doi: 10.1097/ICL.0000000000001231

32. Harthan JS, Shorter E. Therapeutic uses of scleral contact lenses for ocular surface disease: patient selection and special considerations. Clin Optom (Auckl). 2018;10:65-74. doi: 10.2147/OPTO.S144357

33. Geerling G, MacLennan S, Hartwig D. Autologous serum eye drops for ocular surface disorders. Br J Ophthalmol. 2024;88:1467-1474. doi: 10.1136/bjo.2004.044347

34. Yoon H, Harthan JS, Skoog W, Fogt JS, Nau A, Nau CB, et al. Process and outcomes of fitting corneoscleral profilometry-driven scleral lenses for patients with ocular surface disease. Eye Contact Lens. 2024;50:132-137. doi: 10.1097/ICL.0000000000001064

35. Walker MK, Bergmanson JP, Miller WL, Marsack JD, Johnson LA. Complications and fitting challenges associated with scleral contact lenses: A review. Cont Lens Anterior Eye. 2016;39:88-96. doi: 10.1016/j.clae.2015.08.003

36. Macedo-de-Araújo RJ, van der Worp E, González-Méijome JM. A one-year prospective study on scleral lens wear success. Cont Lens Anterior Eye. 2020;43:553-561. doi: 10.1016/j.clae.2019.10.140

37. Balaji J, Subramanian M, Saravanan S, Narayanan A. Cost and benefits of availing specialty contact lenses for irregular cornea and ocular surface diseases from patient perspectives. Cont Lens Anterior Eye. 2025;48:102385. doi: 10.1016/j.clae.2025.102385