Specialty Lenses · Severe Dry Eye · COVE New Albany

Scleral lenses for severe dry eye, in New Albany, Ohio.

When drops, plugs, IPL, and prescription therapy aren't enough, sclerals trap a continuous layer of saline against the eye, all day long.

If drops aren't enough anymore (if you've tried Restasis, Xiidra, plugs, warm compresses, IPL, and you're still ending the day in pain), there's another option most patients don't know about. Scleral contact lenses vault over your cornea and trap a layer of preservative-free saline against the eye all day.

For patients with Sjögren's syndrome, GVHD, severe MGD, post-LASIK dry eye, or other ocular surface disease that hasn't responded to standard therapy, sclerals can be a meaningful step forward. Many severe dry-eye patients are able to tolerate longer, more comfortable wear than they could with prior options. Sclerals don't replace your other dry eye treatments, though. They work alongside them. Most patients continue some version of the drops, lid care, and prescription therapy they were already on, often at a reduced level, because the underlying disease still needs management.

Schedule a dry eye scleral consultation.
01
The Condition

When dry eye becomes severe.

Most dry eye is uncomfortable. Severe dry eye is disabling. The difference is when the eye surface itself becomes damaged. When the cornea develops persistent epithelial defects, when blinking hurts, when vision fluctuates between blinks because the tear film is too unstable to support clear optics.

The patients we see for scleral consultations have usually been through years of escalating treatment:

  • Preservative-free artificial tears every hour
  • Prescription anti-inflammatory drops: Restasis, Xiidra, Cequa, Miebo
  • Punctal plugs, sometimes cauterization
  • Warm compresses, lid scrubs, omega-3 supplementation
  • In-office MGD treatments: IPL, LipiFlow, iLux, manual expression
  • Autologous serum tears
  • Amniotic membrane (Prokera or similar)

If you've tried most of that and you're still in pain, your dry eye has crossed into the territory where the eye surface needs continuous protection that drops can't deliver. That's the gap sclerals fill.

02
The Solution

Why scleral lenses work for severe dry eye.

The mechanism is simpler than most people expect. A scleral lens is a large, gas-permeable contact lens that vaults over the entire cornea and rests on the white of the eye. Before insertion, you fill the bowl of the lens with preservative-free saline. The lens lands on the sclera. The saline stays trapped between the back of the lens and the front of your cornea, all day.

That fluid layer does three things at once:

i.   Hydration

Continuous hydration

The cornea is bathed in saline from the moment you insert the lens until you take it out. The cycle of evaporation, irritation, and reflexive tearing that defines severe dry eye is interrupted while the lens is in.

ii.   Protection

Mechanical protection

The lens shields the cornea from blinking friction, air movement, low humidity, and environmental irritants. For patients with persistent epithelial defects, this protection alone often helps the surface heal in ways drops alone may not.

iii.   Optics

Stable optics

Severe dry eye fluctuates vision because the tear film keeps breaking up. Sclerals replace that unstable surface with a smooth, stable one. Many patients see better in sclerals than in glasses, even before factoring in the dry eye relief.

Cross-section diagram showing how a scleral lens vaults over the cornea and rests on the white of the eye
The lens vaults the cornea entirely; the saline reservoir underneath keeps the surface bathed from insertion to removal.

It's the closest thing in eyecare to wearing a humidifier on your eye.

"Wearing a humidifier on your eye" is the closest patient-facing description we've found. It's not perfect (sclerals do more than just hydrate), but it captures the part that matters: the cornea finally has somewhere to rest.

03
Indications

When scleral lenses are the right answer.

Sclerals are not a first-line dry eye treatment. They're a strong consideration when one or more of these are true:

i.   Autoimmune

You have an autoimmune cause

Sjögren's syndrome, rheumatoid arthritis, lupus, GVHD after bone marrow transplant. The underlying disease attacks the tear glands themselves, and drops alone often can't replace what's missing. Sclerals are often a useful tool in these cases.

ii.   Surface damage

You have ocular surface damage

Persistent epithelial defects, severe filamentary keratitis, neurotrophic keratopathy. The cornea has trouble healing while it's exposed to air and blinking. Sclerals can create a moist, protected environment that supports healing.

iii.   Post-LASIK

Post-LASIK dry eye that hasn't resolved

For most LASIK patients, dry eye resolves within months. For a small subset, it doesn't, and the corneal nerve damage can leave the eyes chronically uncomfortable. Sclerals are often the answer when nothing else has worked.

iv.   Severe MGD

Severe MGD that hasn't responded

When meibomian gland dysfunction is advanced enough that the lipid layer can't hold the tear film together, and IPL, LipiFlow, manual expression, and prescription therapy haven't been enough, sclerals can give the surface the rest it needs.

04
The Fitting

How a scleral fit for dry eye works.

The process for severe dry eye is similar to any scleral fit, but with extra attention to fluid reservoir depth, lens diameter, and edge interaction with the conjunctiva, all of which matter more when the eye surface is already inflamed.

  1. 01
    Routine eye exam plus corneal topography on the Oculus Keratograph 5M. Maps your corneal surface and gives us baseline imaging of the meibomian glands and tear film.
  2. 02
    Anterior segment OCT. Cross-sectional imaging that lets us see exactly how the lens vaults the cornea and how deep the saline reservoir sits, critical for dry eye fits.
  3. 03
    Lens platform selection. Most dry eye fits go to Zenlens® (diagnostic-trial workflow) or WAVE ScleraLens® (built directly from your topography map). The choice depends on your corneal shape and what we see on imaging.
  4. 04
    Custom lens design. The lab manufactures to our specifications.
  5. 05
    Dispense and refinement. Most dry eye fits take 2–4 lens revisions to land on the final design. The fitting fee covers all of those revisions; you do not pay per iteration.
Corneal topographer used to map the eye for scleral lens fitting at COVE in New Albany
Every dry eye fit starts with a detailed map of your cornea, not a guess off a paper prescription.
Wide-field retinal imaging camera used at COVE in New Albany to view the back of the eye, no drops needed for the imaging itself
Severe dry eye evaluations also include imaging of the back of the eye, so we're looking at overall eye health, not just the ocular surface.
05
The Platforms

Why two lens platforms: Zenlens® and WAVE ScleraLens®.

Most scleral practices fit one lens line. We use both, deliberately, because they're built around fundamentally different design philosophies.

i.   Diagnostic-trial

Zenlens®: diagnostic-trial workflow

A diagnostic lens from our trial set goes on your eye. We evaluate the fit in real time (vault, landing on the sclera, edge clearance), then refine the order based on what we see. Strong choice for many dry eye fits, especially when corneal shape is reasonably regular.

ii.   Topography-driven

WAVE ScleraLens®: built from your map

No diagnostic trial. The lens is designed in CAD/CAM software directly from your corneal topography and manufactured to that exact design from the ground up. WAVE has been doing topography-driven scleral design since 1999. This is often the right call when the cornea has been damaged by long-standing surface disease and a stock trial lens won't represent the final fit well.

Having both platforms in-house means we pick the right tool for your eye, not the only tool we happen to carry.

i.  HYDRATION

A saline layer, all day

Preservative-free saline trapped between lens and cornea.

ii.  PLATFORMS

Two scleral platforms in-house

Zenlens® and WAVE ScleraLens®.

iii.  INCLUDED

All fitting revisions included

You do not pay per iteration.

06
Bigger Picture

What scleral lenses don't do.

Sclerals are a tool. They're not a cure.

A tool, not a cure

They do not treat the underlying disease driving your dry eye. Sjögren's still needs systemic management with your rheumatologist. MGD still benefits from lid hygiene, omega-3s, and in-office therapies. GVHD still needs your oncology team. Post-LASIK neurotrophic dry eye may still need ongoing therapy alongside the lenses.

What sclerals do is buy your cornea the protection it needs to function (and often heal) while the underlying condition is being managed elsewhere. The patients who do best are the ones who keep up with their other treatments and use sclerals on top, not instead.

07
Wear & Comfort

What it actually feels like.

Day One

First insertion

First insertion is the hardest moment. You're using a small plunger or scleral ring, holding a lens full of saline, tilting your head. We spend as much time as you need teaching this. Once the lens is on, many dry eye patients describe noticeable relief: the burning eases and the foreign-body sensation tends to settle. Patients often describe the relief as immediate and memorable.

Week One

Settling in

Insertion gets faster. Most patients report comfort that holds through 8–12 hours of wear. Some severe-disease patients refresh the saline midday (pop the lens out, rinse, refill, reinsert) to keep things fresh. Others wear straight through.

Month One

Healing in place

Insertion takes seconds. Routine is established. Many patients report needing fewer drops between wears than they did before. The cornea is healing because it finally has somewhere to rest. We see you back at one week, one month, three months, and six months to confirm the fit and check the corneal surface.

08
Cost & Coverage

What scleral lenses for severe dry eye cost at COVE.

Severe dry eye fits are a medical-necessity scleral fit. For most patients with major vision insurance, total out-of-pocket lands much lower than the sticker price.

Medical necessity

Severe dry eye scleral fit

Usually covered
when the MNCL benefit applies; the fitting and lenses are billed separately

Includes corneal topography, anterior segment OCT, lens design, dispense visit, and the full follow-up schedule. All lens revisions during the fitting period are included. You do not pay per iteration.

Insurance and pricing notes
  • If you have VSP or EyeMed, your out-of-pocket is usually just a small copay. Most VSP and EyeMed plans include a Medically Necessary Contact Lens benefit that applies to severe dry eye fits. When it does, the fitting and the lenses are largely covered. Coverage rules vary by plan, and qualification depends on diagnosis criteria we'll work through at the appointment. Call us with your insurance card; we verify what we can in advance.
  • For coverage, the dry eye usually needs to be documented as severe and unresponsive to standard therapy. Many patients we see already have substantial documentation (they've been escalating treatment for years), but qualification depends on plan criteria we work through at the consultation.
  • All scleral lens costs are FSA and HSA eligible.
  • We recommend annual lens replacement.
09
The Practice

Why patients with severe dry eye come to COVE.

Dr. Matthew Karres has years of clinical experience designing and fitting specialty contact lenses at COVE: scleral, gas-permeable, multifocal, and orthokeratology fits. His research interests within specialty contacts are focused on scleral lens solutions, including for severe dry eye. Severe dry eye is one of the conditions that depth was built for.

What that means in practice:

  1. i.
    Topography- and OCT-driven custom design. Every dry eye fit at COVE starts on the Oculus Keratograph 5M and is informed by anterior segment OCT imaging. We don't fit off a paper prescription; we fit off your actual eye.
  2. ii.
    Two trusted lens platforms. Zenlens® (diagnostic-trial workflow) and WAVE ScleraLens® (built directly from your topography map). Different cases call for different platforms.
  3. iii.
    Coordinated care with your other providers. Severe dry eye almost always involves more than one specialist. We work with your rheumatologist, oncologist, or LASIK surgeon as needed so the lens fit complements, rather than duplicates, the rest of your treatment plan.
  4. iv.
    We don't pass off the hard cases. Persistent epithelial defects, post-transplant GVHD, neurotrophic corneas: these are exactly the fits we take on.
Dr. Matthew Karres, OD, optometrist at COVE in New Albany, Ohio
Dr. Matthew Karres
Doctor of Optometry, The Ohio State University. Years of clinical experience fitting scleral and specialty lenses, with research interests in scleral lens solutions.
The COVE dry eye scleral commitment

Severe dry eye fits are demanding. The lens has to vault enough to leave a fluid reservoir without sitting so high that it disrupts the conjunctiva. We design every fit with that balance in mind. When the first lens isn't right, we keep iterating at no extra fitting fee until it is.

What we ask of you: stick with the rest of your dry eye treatment plan, come to your follow-ups, and tell us specifically what's bothering you when something feels off. Patients who stay engaged get the best results.

Patients who'd been told "there's nothing else to try" for their dry eye are part of our 1,100+ five-star Google reviews. Reviewers with hard-to-fit prescriptions describe doctors who stay with the fit until it’s right, and appointments that don’t feel rushed.

“a next level experience”  ·  “very thorough and patient on everything”  ·  “I don’t trust anyone else with my eyes”

Read the reviews for yourself on Google →
10
Questions

Frequently asked questions.

Q.01 Will I still need drops and other treatments if I wear sclerals? +
Yes, almost always, at least to some degree. Sclerals are remarkably effective at protecting the eye surface during wear, but they don't treat the underlying disease driving your dry eye. Most patients continue some version of what they were already doing: preservative-free drops in the morning before insertion and in the evening after removal, lid hygiene, omega-3 supplementation, and prescription drops like Restasis or Xiidra if they were helping. The relentless hourly drop routine almost always becomes unnecessary, but the foundational treatments stay in place. The patients who do best are the ones who use sclerals on top of their existing care, not as a replacement for it.
Q.02 Can I sleep in scleral lenses? +
No. Sclerals are designed for daily wear only. The fluid reservoir works because tears can refresh under the lens during a blink. That exchange stops if you sleep in them, and you risk corneal hypoxia. Take them out before bed.
Q.03 I have Sjögren's. Will sclerals help? +
Often, yes, and they're one of the most effective tools we use for Sjögren's-related dry eye. Sjögren's destroys the tear glands themselves, which is why drops alone often can't keep up. The continuous saline reservoir under a scleral lens replaces what your own tear film can't produce. We coordinate with your rheumatologist on the systemic side.
Q.04 I had LASIK and my eyes have been dry ever since. Can sclerals help? +
Yes. Post-LASIK dry eye is one of the indications we see most often. The corneal nerve damage from LASIK leaves some patients with chronically uncomfortable, fluctuating eyes that don't respond to standard therapy. Sclerals can make a major difference for this group.
Q.05 What if I wear sclerals and my dry eye still doesn't fully resolve? +
That happens. Sclerals are remarkably effective but they're not a cure. For some patients we layer additional therapy on top: continuing prescription drops between wears, autologous serum tears, addressing meibomian gland dysfunction with in-office treatment, or working with your other specialists on the underlying disease. We design the plan around your specific situation.
Q.06 How do I clean a scleral lens? +
You rinse with preservative-free saline, clean with a designated rigid lens cleaner, and store in fresh disinfecting solution overnight. We walk you through the routine at the dispense visit. It's straightforward, and most patients have it down within the first week.
Q.07 Will my insurance pay for this? +
If you have VSP or EyeMed and your plan includes the Medically Necessary Contact Lens benefit, your out-of-pocket for the fitting plus lenses is usually just a small copay. Severe dry eye documented as unresponsive to standard therapy is exactly the kind of diagnosis the benefit was built for. Coverage rules vary by plan; we run a benefits check before your consultation and work through whether your specific case qualifies together at the appointment.
Next Step

Schedule a dry eye scleral consultation.

If you've been told there's "nothing else to try" for your dry eye, that isn't true. The next step is a corneal surface evaluation, topography scan, and a conversation about whether sclerals are likely to help in your situation. We can do all of that at your next routine eye exam.

Related reading: our scleral lens hub  ·  sclerals for keratoconus  ·  sclerals for irregular and post-surgical corneas