What Eye Drops Can I Use With Scleral Lenses?

Why Scleral Lens Wearers Need Drops Specifically

Scleral lenses vault over the cornea and rest on the sclera, creating a fluid-filled space between the lens and the eye’s surface. That reservoir is the reason scleral lenses transform life for people with severely irregular corneas — they replace the cornea’s optical role with the lens’s perfect curvature and bathe the eye in constant lubrication. But that reservoir also means your drops are doing two different jobs: filling the reservoir before insertion, and refreshing moisture during long wear. The drops suited for each role are different, and mixing them up is the single most common mistake new scleral patients make.

Our broader guide on what scleral lenses actually are covers the design in more detail, and how scleral lenses improve vision in irregular corneas explains why reservoir hydration is non-negotiable.

Reservoir Fill — The Drop That Goes Inside the Lens

Before you insert a scleral lens, you fill the concave side — the bowl — with preservative-free saline. This fluid sits against your cornea for the entire wearing day, making the choice of saline unusually high-stakes. Two rules are non-negotiable: preservative-free only, and designed for ophthalmic use only.

FDA-cleared options most widely used by scleral patients include LacriPure, ScleralFil, and Purilens Plus. These single-use vials are isotonic (matched to natural tear salinity), sterile, and free of the preservatives that damage the corneal surface with chronic exposure. Multi-use preserved saline bottles — even those labelled “for sensitive eyes” — contain agents like benzalkonium chloride that scleral wearers should never put into the reservoir. Tap water, bottled drinking water, and contact-lens solution with cleaning agents are all flatly unsafe in the reservoir and have been linked to serious corneal infections including Acanthamoeba keratitis.

If you are also managing dry-eye disease, our article on what causes dry eyes covers the underlying drivers worth addressing alongside lens wear.

Over-Lens Lubrication — Comfort Drops During Wear

Even with a perfect reservoir, most scleral wearers experience some end-of-day dryness as the fluid exchanges with the tear film and the lens surface itself dries slightly. Contact-safe preservative-free lubricating drops are designed for this — they are applied directly onto the eye while the lens is in place, and their formulation is engineered not to cling to or cloud the lens material.

Widely used options include Refresh Contacts, Blink Contacts, and Systane Ultra PF. Look for the “safe for contact lens wear” label, the “preservative-free” designation, and a single-use vial or preservative-free multi-dose bottle. Drops that are not labelled contact-safe may contain mild oils, lipid components, or viscosity agents that leave residue on the lens surface, producing that frustrating mid-afternoon cloudy vision that won’t blink away.

Overnight and Post-Removal Drops

Thick lubricating gels — Refresh Lacrilube, GenTeal Tears Severe Dry Eye, Systane Nighttime — are excellent for the dryness that may persist after lens removal at the end of the day, but they are never applied during lens wear. Their viscosity is designed to coat the eye slowly overnight, exactly the property that would blur vision and cling to the lens surface if used while sclerals are in place. Apply these after removing your lenses, ideally at bedtime. If you are prone to waking with dry, irritated eyes, morning dry eye covers the underlying causes and management strategies.

Prescription Drops With Sclerals

Medicated eye drops — steroids like loteprednol, immunomodulators like cyclosporine, antibiotic drops, glaucoma drops — each require a specific conversation with your prescribing clinician about scleral compatibility. Some are safe to use with lenses in. Others must be instilled before lens insertion or after removal to avoid preservative build-up in the reservoir or altered drug absorption. Autologous serum drops, sometimes prescribed for severe ocular surface disease, are typically used with lenses in but need specific storage and handling.

Never assume a prescription drop is compatible without asking. Compatibility depends on the preservative system, viscosity, and intended mechanism of the medication — and your lens fitter or ophthalmologist will give you the correct instruction for your specific regimen.

Drops to Strictly Avoid

• Anything containing benzalkonium chloride (BAK) — this preservative accumulates in the reservoir and causes progressive ocular surface toxicity. Many multi-use drops include it; check the label.
• Redness-reducing drops (containing tetrahydrozoline, naphazoline, or brimonidine for cosmetic use) — these are vasoconstrictors that mask rather than treat the cause of redness, and long-term use can worsen ocular surface health. Scleral patients should never use them over their lenses.
• Oily or lipid-based drops not labelled contact-safe — leave residue on the lens surface, produce fogging, and are difficult to clean off.
• Thick gels and ointments during wear — cause immediate blurring and cling to the lens.
• Multi-purpose contact lens solutions — formulated for cleaning, disinfecting, and storing, not for eye use. They contain cleaning agents that should never touch the cornea directly.

How to Apply Drops With Sclerals In

The mechanics matter because the wrong technique can displace the lens or introduce contamination. First, wash your hands thoroughly and dry on a clean towel. Confirm the drops are preservative-free and contact-safe. Tilt your head slightly back and look up; pull down the lower lid gently. Instil one drop — two at most — directly into the lower fornix, not onto the lens centre. Blink slowly a few times to distribute across the lens surface. Avoid touching the dropper tip to your lashes, the lens, or any surface. Our broader article on inserting and removing scleral lenses covers the full handling technique, and cleaning scleral lenses covers end-of-day care.

Signs You Need to Reach for Drops

Scleral wearers quickly learn the cues that mean add moisture. Watch for lens fogging — the reservoir has concentrated and needs refreshing. Mild blurring that clears briefly with a blink often points to surface dryness. Gritty or scratchy sensation, especially in the afternoon, signals tear film depletion outside the lens. Increased awareness of the lens edge is often the first sign. Reaching for drops proactively — before the symptom becomes obvious — is the habit that separates comfortable long-day wearers from those who struggle. Dry eye symptoms are worth knowing in detail since many scleral patients have underlying ocular surface disease alongside their corneal condition.