A new case report highlights a rare but serious complication associated with scleral lenses, which are increasingly prescribed for patients who have corneal irregularities and ocular surface disease.

The report describes a 43-year-old man with keratoconjunctivitis and keratoconus who developed an intracorneal hemorrhage within 4 hours of his first scleral lens training session. The hemorrhage expanded rapidly after lens removal, though it resolved without intervention over several weeks. The patient was later refitted with fenestrated scleral lenses and has worn them successfully for more than a year without recurrence.

Scleral lenses are designed to vault over the cornea and rest on the sclera, creating a fluid reservoir that protects the ocular surface and improves vision. While most complications previously reported involve microbial keratitis or hypoxia, this case suggests that mechanical interactions—including suction during lens removal or trauma from handling—may also cause ocular injury.

According to the authors of this report, literature on scleral lens complications remains limited, with no large-scale epidemiological studies available. Existing reports describe microbial keratitis, corneal abrasions, graft rejection, and epithelial changes linked to hypoxia or mechanical stress. Therefore, the authors recommend that clinicians minimize suction forces through lens design modifications, such as channels or fenestrations, and provide careful training for patients at higher risk of ocular fragility.