Why the fill solution matters
If you wear scleral lenses, you have probably been told to rinse and fill them with preservative-free sterile saline. Maybe you have wondered whether the bottle on the shelf makes a difference. It does. A scleral lens holds a reservoir of fluid over your cornea for hours. That fluid stays in contact with your eye for about 4 hours before it interchanges with your natural tears. If the solution is not preservative-free, the irritant sits against the eye for many hours.
What to use
Scleral lenses are supposed to be filled with preservative-free sterile saline. This is a mixture of sodium chloride 0.9%, which is physiologically similar to your natural tears.
The brands we most often discuss with patients include Modudose (also sold as Addipak), Lacripure, and ScleralFil. We may recommend a particular product based on your eyes and your routine, so use the one you were trained on, and ask before switching. ScleralFil typically feels the best for patients with dry eye because it is the only preservative-free saline that is pH balanced. However, some patients feel better without the buffering agents, so sometimes trying a few different types can help you narrow down which works best for you.
What to avoid
Do not fill your lens with multipurpose solution (aka, the solution you use to clean your lenses with overnight, soft contact lens solutions, or rigid contact lens solutions). Multipurpose solutions contain preservatives, and those preservatives are not meant to sit against the cornea all day. The preservatives are there for a purpose: to kill bacteria! Don’t let them kill the natural cells of your eye too!
You also must avoid tap water to do anything: rinse the lenses, clean the lenses or clean your lens cases. Even having very wet hands when inserting your contact lenses must be avoided. Tap water can carry a very serious microorganism called acanthamoeba keratitis which can cause extremely painful and difficult to get rid of infections. Google acanthamoeba corneal infection, if you want to be scared straight!
Saline and rewetting drops are different jobs
This preservative-free saline fills the bowl of the lens and forms the reservoir that bathes your cornea. Rewetting drops go on the surface of your eye, and contact lens, during the day. If you use drops with your scleral lenses, choose preservative-free options, and ones that are free of oils. Your doctor can tell you which ones fit your routine.
If you are on vacation and you forget your saline solution, you CAN use preservative-free artificial tears in the bowl of your scleral lenses. However, if you do this long-term it can get expensive!
How to fill your lens correctly
Fill the bowl completely, until the saline forms a slight dome above the edge of the lens. Most scleral lenses hold about 1 mL, depending on their size. Here is the routine we recommend:
- Wash and dry your hands before you start.
- Rinse and rub the lens with saline so you remove any of the overnight cleaning solution, as well as remove any biofilms from the lenses.
- Fill the bowl with preservative-free sterile saline until a slight dome forms above the edge.
- Insert the lens right away, keeping the bowl full so that no air is trapped under it.
- If you see a bubble after insertion, remove the lens, refill it completely, and reinsert it. Bubbles do not dissolve on their own.
If your lens has fenestrations, which are small holes that can improve oxygen flow and reduce suction, you may not see a perfect dome. Fill the bowl as much as you can anyway. The goal is a full reservoir.
Your takeaways
- Fill your lens with preservative-free sterile saline every time you insert it.
- Fill until a slight dome forms above the edge of the bowl.
- Never use multipurpose solution or tap water in the bowl of the lens.
- If a bubble appears after insertion, remove the lens, refill it completely, and reinsert it.
- Carry a travel supply of preservative-free saline so you never have to improvise.
Frequently asked questions
Can I add a little saline on top of the lens once it’s on my eye when I feel dry?
Of course! Sometimes you have a lot of saline left over, and since you have to get rid of the vial after a day (due to potential for bacteria), just use it to rinse your eyes in the morning, lubricate the eye when you need to during the day, and lubricate the eye before you go to bed at night.
Do I need to refill the lens each time I put it in?
Yes. Fill the bowl fresh before every insertion or you will get an air bubble!
Can I use the saline that is at the drugstore, such as the pharmacy brand saline solution?
No! Those large bottles of saline at the drugstore have preservatives (chemicals) in them to keep out bacteria. You cannot fill your lens with that saline or it will damage the front cells of your eye and give you a mild chemical reaction.
Bottom line
The solution you put behind your scleral lens is part of your daily eye care. Preservative-free saline, a full bowl, and a good insertion are the key to keeping your cornea comfortable from morning to night. If something still feels off after you have filled the lens correctly, call our office. We would rather hear from you early than after a week of discomfort.
Next step
Not sure whether your current solutions are the right ones for your scleral lenses? Call or text us at 480-420-4243 or book a visit with us! We are glad to review your routine with you, whether you live in Scottsdale or are working with us from across the country.
