Review article
Anatomical and physiological considerations in scleral lens wear: Eyelids and tear film

https://doi.org/10.1016/j.clae.2021.01.002Get rights and content

Abstract

Scleral lenses can affect a range of anterior segment structures including the eyelids and the tears. The eyelids, consisting of the outer skin layer, the middle tarsal plate, and the posterior palpebral conjunctiva, provide physical protection and house the meibomian glands and cilia which have important and unique functions. Tears consist of a mix of aqueous, mucus, and lipidomic components that serve vital functions of lubricity, protection, and nourishment to the ocular surface. Both the eyelids and the tear film interact directly with scleral lenses on the eye and can affect but also be impacted by scleral lens wear. The purpose of this paper is to review the anatomy and physiology of the eyelids and tear film, discuss the effects and impacts of the scleral lenses on these structures, and identify areas that require further research.

Introduction

Despite the developing body of scientific literature on scleral lenses [1] and the growing number of eye care providers utilizing them to manage corneal irregularity, ocular surface disease, and even uncomplicated refractive error [2,3], there is still a limited understanding of the impact of scleral lenses on ocular surface tissues and the tear film. With the objective of providing a comprehensive analysis of the current knowledge regarding scleral lens effects on the eye, this manuscript is part two of a series reviewing the anatomical and physiological considerations in scleral lens wear [4]. Here the focus is on the structural and functional aspects of the eyelids and the tear film and how they can affect and be modified in scleral lens wear.

Section snippets

Eyelids and lashes

The eyelids and lashes maintain the physiological integrity of the anterior ocular surface by evenly distributing the tear film and protecting the cornea and conjunctiva from airborne particles [5,6]. They help maintain the position of the globe within the orbit, regulate the amount of light that enters the eye [7], and are important to consider when prescribing scleral lenses. Features such as fissure size, lid tension, and pre-existing lid pathology may influence lens selection and the lens

The tear film

The human tear film is 2–50 μm thick and contains thousands of proteins, peptides, lipids, electrolytes, gases, and metabolites. This fluid prevents desiccation, protects from invading microorganisms, and provides an optically smooth refractive interface. While all contact lenses disturb the natural tear film, scleral lenses are unique in that they trap a large reservoir of fluid between the lens and the cornea, which drastically alters the natural tear film. Several studies have examined how

Discussion and conclusion

The current literature shows prolific use of the scleral lens to treat eyelid-related diseases and structural abnormalities. Scleral lens practitioners can safely treat conditions such as Sjögren’s syndrome, Stevens-Johnson syndrome, Bell’s Palsy, and other diseases causing extreme dry eye and ocular surface exposure and/or breakdown. In these patients, the underlying disease is an important consideration and there are often sequelae such as poor lens wetting, deposits, as well as conjunctival

Acknowledgements

The authors would like to thank Dr. Jan PG Bergmanson, OD, PhD for his thoughtful and productive discussions regarding this manuscript.

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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