Scleral Lens Issues and Complications Related to a Non-optimal Fitting Relationship Between the Lens and Ocular Surface

INTRODUCTION: The advent of high oxygen permeability (Dk) of rigid contact lens materials has reduced complications related to hypoxia when using scleral contact lenses (ScCLs). However, new issues and complications have emerged. Some of these issues and complications are caused by the nonoptimal fitting relationship with the underlying ocular surface, which may pose a challenge in their management. METHOD: PubMed searches using different keywords and an investigation into the issues and complications etiology were conducted. Detailed guidelines for their management are provided. RESULTS: The literature provides a few reports of severe adverse reactions to ScCLs. The most common issues, unique to ScCL wear, have been described. Likewise, other anomalies in ScCL fitting may affect patient satisfaction and lead to drop out, promoting eye surgery or dramatic psychological effects. The management of these issues and complications may be also frustrating for clinicians who will, in turn, rarely, or not at all, prescribe them. CONCLUSION: Scleral contact lenses intimidate practitioners because of their large diameter and the lack of knowledge in regard to the fitting process but especially because of the challenging management of issues and complications that may occur relating to the lens fitting relationship with the underlying ocular surface. A detailed description of the etiology and management of these anomalies will allow practitioners to gain more confidence in fitting ScCLs and prescribe them more often. Patients are the primary beneficiaries from wearing these large rigid lenses; ScCLs represent a life-changing event for many patients.