Keratokonus – the killing application for most contact lenses is the prototypical job for sclerals

Summary Use of blown glass shells, the precursors of scleral lenses, for management of keratoconus was first described in the late 1800's. Keratoconus has been a leading indication for scleral lenses throughout the history of the devices, both prior to and following the introduction of rigid gas permeable scleral lenses in 1983. Scleral lenses offer several benefits compared to corneal lenses for primary corneal ectasia. They do not require alignment with a highly irregular corneal surface, and are instead supported by the conjunctival tissue overlying the relatively regular sclera. They offer excellent comfort and lens stability. Scleral lenses do not touch the cornea, so may be less likely to lead to corneal epitheliopathy or scarring. Unlike corneal transplantation, scleral lenses can immediately provide improvement in the quality of vision, and are considerably less invasive. Furthermore, scleral lenses may provide improved ocular comfort for patients with concurrent keratoconus and atopic disease of the lids and adnexa. This presentation will review and summarize visual and ocular outcomes of scleral lens therapy for management of exposure keratopathy at the Mayo Clinic.