Scleral Lenses for Ocular GVHD: Eye Protection, Comfort and Vision

Ocular graft-versus-host disease can make the eyes persistently dry, painful and sensitive to light after an allogeneic stem cell or bone marrow transplant. For selected patients whose symptoms continue despite conventional treatment, scleral lenses may help protect the cornea and improve visual function.

What is ocular GVHD?

Graft-versus-host disease occurs when donor immune cells react against the recipient’s tissues. When the eyes are affected, inflammation can disrupt tear production, destabilise the tear film and damage the corneal and conjunctival surfaces.

Symptoms may include burning, grittiness, redness, light sensitivity and fluctuating or persistent blur. Not every dry-eye symptom after transplant is necessarily GVHD; an examination is needed to identify the cause.

How scleral lenses protect the eye surface

Scleral lenses are rigid gas-permeable lenses that vault over the cornea and are supported by the tissues over the sclera. Suitable sterile, preservative-free saline is placed in the lens bowl before insertion. The resulting fluid reservoir maintains a moist environment over the cornea during wear.

This can reduce dryness-related discomfort and direct exposure to wind, air conditioning and eyelid friction. It may support a vulnerable corneal surface, but active inflammation, infection or epithelial breakdown requires specialist medical assessment and supervision.

How they may help vision

A stable tear film and regular corneal surface are important for clear vision. In ocular GVHD, dryness and surface irregularity can interfere with focusing, so changing spectacles alone may not resolve the problem.

The rigid lens provides a regular front optical surface, while the fluid reservoir compensates for some underlying corneal irregularity. This may reduce blur or fluctuation and make reading, computer work and other daily tasks easier.

Outcomes vary. Corneal scarring or problems elsewhere in the eye may limit improvement. Scleral lenses cannot correct every cause of reduced vision.

What is PROSE treatment?

PROSE stands for Prosthetic Replacement of the Ocular Surface Ecosystem. It is a specialised treatment approach using individually designed scleral-type devices to support the ocular surface and visual function.

PROSE and other scleral lenses share the principle of vaulting the cornea with a fluid reservoir, but their design, fitting pathway and treatment protocols should not be assumed to be identical. Suitability and access depend on specialist assessment and availability of appropriately trained services.

Read our PROSE overview for background on this treatment approach.

What does research show?

A 2024 retrospective study of 31 people with chronic ocular GVHD reported better visual acuity and ocular surface measures after mini-scleral lens fitting. Some participants discontinued lens use. A separate survey reported improvements in symptoms and quality of life among scleral lens and PROSE users.

These findings support considering treatment for selected patients, but observational studies and patient surveys do not guarantee an individual result. Clinical selection, successful fitting and ongoing care remain essential.

Who may be suitable?

A specialist considers the condition of the cornea and conjunctiva, severity of dryness, previous treatment response, visual needs and ability to manage lens care. Conjunctival scarring or adhesions can make fitting more difficult.

Assessment should be coordinated with the ophthalmologist and transplant team. These lenses do not treat the underlying immune disorder and should not replace prescribed systemic or ocular treatment.

What does treatment involve?

1. Clinical assessment: review of transplant history, eye symptoms, medicines and previous treatment, with examination of the tear film and ocular surface.

2. Individual fitting: trial lenses and measurements to assess corneal clearance, landing, comfort and vision.

3. Practical training: supervised instruction in insertion, removal, cleaning, disinfection and filling.

4. Regular review: checks of surface health, fit and visual performance, with adjustment when needed.

Bring your current eye drops and lens-care products to appointments so the practitioner can review how they fit into the plan.

Hygiene and warning symptoms

Risks include infection, corneal swelling, inflammation, discomfort and lens fogging. Follow the prescribed wearing schedule and care system. Use only recommended sterile, preservative-free filling saline; it is not a disinfectant. Never rinse or fill lenses with tap water or homemade saline.

Do not swim or shower in lenses. Do not sleep in scleral lenses unless a specialist has explicitly prescribed and supervises a therapeutic overnight-wear protocol. Remove the lens and seek prompt care for increasing pain, redness, discharge, unusual light sensitivity or sudden vision change. Do not reinsert it until advised.

Frequently asked questions

Can lenses replace my eye drops?

Usually not. Lubricants and prescribed anti-inflammatory medicines may still be needed. Follow your treating clinician’s instructions.

Are scleral lenses better than glasses?

They may offer additional benefit when surface irregularity or dryness limits spectacle vision. Glasses remain appropriate when they provide adequate vision and symptoms are controlled.

Will every patient with ocular GVHD benefit?

No. Suitability, comfort and visual improvement vary, and some people cannot manage or tolerate lens wear.

Discuss a specialist evaluation

If dryness or blurred vision continues despite treatment, ask your eye care team whether a scleral lens assessment is appropriate. Contact Nexus Vision Eye Care to discuss an appointment, or read about scleral lens fitting.

Research references

• Visual and ocular surface benefits of mini-scleral contact lenses in chronic ocular GVHD (2024).

• Scleral lens and PROSE utilisation in ocular GVHD: a survey study (2021).

About the author

Kiran Challa, Specialist Optometrist. His clinical interests include specialty contact lenses for complex corneal conditions and orthokeratology for myopia management.

Updated 22 October 2026. This article is for patient education and does not replace an individual eye examination or professional advice.