Insertion of Scleral Trial Shell or Prosthesis
Over a Dysfunctional Globe
(Instructions for Caregiver)
Insertion Technique: The
best method for placing a scleral cover shell over a corneal
sensitive eye is with the use of the fingertips, rather than
a suction cup. You will have better control of the
unit. Whereas, using a suction cup, a blink reflex
or an uncontrollable squeezing of the eyelids during the
insertion process could cause a loss of suction, and if the
shell was partially over the globe, the edge of the shell
may hit or rub against the cornea causing discomfort and
Step 1. All Important Hygiene Care
- Scrub Hands and Fingertips:
A thorough hand scrub with emphasis on the fingertips
is necessary to prevent introduction of bacteria to
the eye. We recommend using a 'no more tears'
baby shampoo for this cleansing process, because it
- Hygiene for Eyelids and Lashes:
Another source of bacteria and irritation to the eye is
the crusting of secretions on the eyelids and eyelashes,
so it is best to clean this area prior to insertion of
the shell. Apply a warm wet facecloth with the 'no
more tears' shampoo on the eyelids. Let it remain
for a few moments to soften the crusted secretion, then
wipe it clean. There should be no concern about
stinging or smarting of the eyes, since the shampoo has
a neutral pH.
- Cleansing of Scleral Shell:
Even though the scleral shell is cleaned immediately
after removal, it is a good habit to clean it again
prior to its insertion. You may give it a gentle,
but vigorous rubbing with the shampoo soaked facecloth.
Rinse it well.
Step 2. Moisten Shell Prior to Insertion:
We would recommend a drop of hard or soft contact lens wetting
solution be placed on the shell. This will allow for
a more comfortable insertion of the shell between the lids
and the eye, although some patients (with less corneal sensitivity)
do moisten with water.
Step 3. How to hold the Shell (The black marking
hold of the inner and outer edge of the shell with the thumb
and forefinger. (The index finger will be utilized
in Step #5)
Note shell markings: The
single black dot is the top of the left eye shell while the
double dots indicate top of the right shell.
Step 4. Preparation for Insertion of the Scleral
Have the patient look downward. This will allow
most of the cornea to be protected by the lower eyelid.
Then place your thumb of the free hand on the patientís
upper eyelid and lashes and draw the lid upward.
Step 5. Insertion
A. Partial Insertion: Bring
the top edge of the scleral shell past the lower eyelid
and beyond the upper edge of the cornea prior to setting
it flush over the globe. At this juncture, place
the index fingertip on the front of the scleral shell
to hold it in position. Withdraw the thumb and forefinger
B. Complete Insertion: Once
the index finger has made contact with the shell, release
hold of the upper eyelid and pull the lower eyelid downward
past the lower edge of the shell. The scleral unit
should now be setting flush on the globe.
Step 6. Closing the eyelids:
- Squeeze the Eyelids:
Close the eyelids tightly and gently press on the lids
with your finger for several seconds to allow any trapped
air between the shell and the eye to be released.
- Relax the Closure of Eyelids:
Continue to keep the eyelids shut, but let it be with
a more relaxed mood for at least 30 seconds to a minute.
For a more corneal sensitive eye, this may take three
to five minutes to dispel any foreign body reaction.
Step 7. Follow your wearing schedule:
- Phase I Scleral Trial Shell:
Follow the wearing schedule as planned for you.
Do not exceed the timetable. If you have a corneal
sensitive eye, we must gradually increase your wearing
time (with wearing comfort) to at least 8 hours.
- Phase II Scleral Ocular Prosthesis:
The object is to wear your scleral prosthesis with
comfort for all of your waking hours. If you
do experience a burning sensation or irritation for
at least ten minutes, remove the prosthesis and look
under your eyelid for any loose eyelashes or a dirt
speck. Also check the scleral prosthesis.
Do not replace it if the eye