Gas permeable (GP) and scleral lenses provide optical precision and therapeutic value that soft lenses often cannot achieve. Whether prescribed for keratoconus, high myopia, irregular astigmatism, or post-surgical corneas, these lenses interact with the ocular surface in fundamentally different ways. Their material properties and tear film dynamics require care systems that are not merely compatible—but specifically formulated.

Modern GP and scleral lenses are typically manufactured from high–Dk fluorosilicone acrylate copolymers. These materials combine oxygen permeability with surface wettability, yet their hydrophobic components predispose them to lipid deposition. Unlike hydrogel lenses, which absorb aqueous-phase components into their polymer matrix, GP materials preferentially attract nonpolar tear film elements, particularly cholesterol, phospholipids and wax esters.

Scleral lenses, due to their larger diameter and post-lens tear reservoir, add another layer of complexity. The posterior surface remains in prolonged contact with a relatively stagnant fluid reservoir, which can accumulate particulate debris and denatured proteins over the course of the wearing day. In some eyes, inflammatory mediators including IL-1β, TNF-α, and matrix metalloproteinases have been detected in the post-lens tear film, with levels influenced by lens fit parameters such as limbal clearance.

For both lens types, the care regimen must effectively address:

• Lipid deposits
• Protein buildup

Surfactant systems and chelating agents therefore play a critical role in maintaining surface wettability and long-term material performance. Mechanical rubbing during cleaning significantly improves deposit removal and should also be emphasized in patient education.

Patients with keratoconus, pathologic myopes and those that have undergone refractive surgery, frequently present with an unstable tear film. In keratoconus, tear breakup time drops, goblet cell density decreases, and conjunctival squamous metaplasia develops, all worsening with disease severity. The lipid layer also thins in moderate-to-severe cases, correlating with increased corneal curvature. Patients with pathologic myopia demonstrate reduced tear breakup time and higher OSDI scores. In post-refractive surgery, corneal nerve transection (especially with LASIK flaps) disrupts the corneal-lacrimal reflex arc, reducing aqueous and lipid tear secretion and destabilizing the tear film for months to years. Scleral lenses, by design, vault the cornea and create a fluid reservoir. While this protects the corneal epithelium, it also creates a semi-closed microenvironment. Inadequate cleaning may lead to increased turbidity of the reservoir, midday fogging, and as a result reduced visual quality.

The composition of care solutions – preservative systems, buffering agents, and wetting components – must therefore support both material integrity and pre-lens tear film biocompatibility.

Multi-purpose solutions for GP and scleral lenses should be evaluated based on three main components:

• Surfactant system for lipid and debris removal
• Disinfecting agents for microbial safety with acceptable ocular surface biocompatibility
• Buffering and wetting agents to maintain physiologic pH and surface stability

Particularly in specialty lens wearers with keratoconus or chronic dry eye, harsh preservatives may exacerbate epithelial compromise. A balanced formulation that ensures antimicrobial efficacy while minimizing ocular surface stress is preferable.

Similarly, lubricating drops used during wear should be preservative-free or formulated for frequent instillation, especially in scleral lens wearers where tear exchange is minimal.

Keratoconus patients often rely on GP or scleral lenses as a primary visual rehabilitation strategy. Long-term success depends not only on lens fit but also on maintaining surface quality. Deposit accumulation increases scatter, reduces contrast sensitivity, and may accelerate intolerance.

The subclinical inflammatory tear environment and compromised ocular surface associated with corneal ectasia further underscore the importance of meticulous lens hygiene and selection of care solutions with favorable biocompatibility profiles.

A structured daily care regimen should include thorough digital cleaning with a surfactant-based multi-purpose solution, adequate rinsing, and complete disinfection cycles. In scleral lens wearers, attention to reservoir filling solutions and midday lubrication is equally important.

A balanced multi-purpose solution such as WE CARE supports effective cleaning while maintaining material wettability. For intra-day comfort and tear film stabilization, WE FRESH Lubricating Eye Drops can be integrated safely into the wearing schedule, before inserting or after removing lenses.

GP and scleral lenses are precision medical devices. Their success depends not only on fitting expertise but on material-conscious aftercare. Understanding polymer chemistry, tear film dynamics, and solution composition allows us to guide patients toward long-term tolerance, stable vision, and ocular surface health.

Specialty lens care is not an accessory recommendation: it is part of the treatment plan!

#BECAUSEWECARE

Visual quality with corneo-scleral contact lenses for keratoconus management (2018): https://pubmed.ncbi.nlm.nih.gov/29398334/

Comparative Analysis of Tear Proteins in Keratoconic Scleral Lens Wearers with Variation in Limbal Clearance (2021): https://onlinelibrary.wiley.com/doi/10.1097/OPX.0000000000001645

Tear dynamics under scleral lenses (2019): https://pubmed.ncbi.nlm.nih.gov/30545775/

Effect of Scleral Lens Oxygen Permeability on Corneal Physiology (2020): https://pubmed.ncbi.nlm.nih.gov/32932393/

Quantifying the Optical and Physical Consequences of Daily Cleaning on Conventional and Wavefront-guided Scleral Lenses (2020): https://pubmed.ncbi.nlm.nih.gov/32941335/

Scleral Lens Fenestrations and Fluid Reservoir Debris (2026): https://pubmed.ncbi.nlm.nih.gov/42501255/

About Cleaning, Disinfecting, and Storing Contact Lenses (2025): https://www.cdc.gov/contact-lenses/about/about-cleaning-disinfecting-and-storing-contact-lenses.html