Sclerals

[patrick]

I have a question about wearing scleral lenses.
Maybe it's a really dumb question,but i'd like to ask it anyway.
In my understanding it's, among other things,the function of the nerve endings in the cornea to detect dryness and to send messages to the brain to set in motion the whole cyclus of blinking,production of the aqueous part of tears and the production of lipids for the meibomian glands.
If so,won't sealing the cornea with a lens that is even filled with moisture disrupt this function? I mean,this way the cornea is a 100% wet all the time during the period the sclera lens is there,so the brain is sort of fooled and has no reason to make tears and make you blink in time or maybe at all.
Yep,maybe these thoughts are a little far fetched,but still in theory this could be possible.
Or not?

Someone here who can explain a little about this?

Patrick...

[Rebecca Petris]

I don't really know the answer to your question but I will share some thoughts.

Most people who use sclerals for dry eye have such a drastically impaired tear making capacity that even if the kind of disruption of nerve function you're suggesting happened, it wouldn't matter, because the nerves aren't resulting in the tear production anyway and keeping the corneal surface lubricated is simply a practical necessity in order to preserve vision. (I'm talking about GvHD, SJS etc cases.)

Some people are using sclerals in certain much more moderate dry eye cases where pain seems to result from even the slightest stimulus to the cornea nerves so insulating those nerves becomes the safest way to stop triggering pain.

In addition keep in mind that the tear system is not all about the cornea although that's the part we're usually mainly occupied with. The tear layer is designed to cover all ocular surfaces, that is, all of the undersides of the eyelids (top & bottom) as well as the sclera and limbus, and production of the various tear components is not just based on corneal nerves - it involves a much more complex mechanism including the routine pumping action of eyelids, stem cells in the limbus etc.

[shanku]

Very interesting question indeed...was thinking of discussing the same the other day. Have been experiencing this dry eye dilemma over the years.

Was wondering if there is any publications or studies on this topic?

Without preventive and protective interventions, the dry eye journey has been a wild ride - constant burning, pain, abrasions, scarring etc.

Now to avoid these more protections I take, feel that the eyes are getting more temperamental and worse off down the line. This has been my trajectory and looks like I am on a downward spiral:

Started with Restasis + tear drops --> Punctal plugs (lowers) + tear drops --> Cautery(lowers) + tear drops + night-time protection --> Cautery + Punctal plugs(uppers) + tear drops + night-time protection --> Cautery + Punctal plugs(uppers) + Sclerals with re-wetting tear drops + moisture chamber glasses + Serum eye drops + night-time protection

Not sure if this is because the dry eye disease has progressed or because of these increased interventions over the years - in the hope that it may help reduce overall inflammation and thereby possibly allowing improved tear/lipid production over time due to less inflammation. Came across this Dry Eye feedback loop sometime back on this board which suggests reducing inflammation may help?!

http://www.focusondryeye.com/_profes...E_clinical.htm

But is that the way to go over long term? or does this methodology address the root causes of one's dry eye problem in first place? or are these protections are just giving temporary relief and over time causing alteration of the eye feedback loop and thereby making one more dependent on them? Sounds like a vicious cycle.

Also, I think a major part of the problem is coming from staring at computer for 8-12 hours a day with minimal blinking. To go on with one's daily life one can not do without these either to remain functional.