Removal of Scleral Trial Shell or Prosthesis
from a Corneal Sensitive Globe
(Instructions for Caregiver)
Method 1 - Removal Technique with Suction
Cup: The best method for removal of a scleral
cover shell from a corneal sensitive eye is with the use
of a suction cup. Unlike the insertion where the fingers
have the most control, removal is better controlled with
a suction cup. The reason being it may be more difficult
to grasp the edges of the shell without fingernails, or conversely
you may irritate the underlying globe with long fingernails.
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 destroys bacteria.
- 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.
Step 2. The Eye Position:
Have the patient look downward. This will allow most
of the cornea and the conforming shell to show a downward
Step 3. The Suction Cup:
Moisten the open end of the suction cup with water and squeeze
it halfway up the barrel with your thumb and index finger.
Step 4. Elevate the Upper Eyelid:
Place the thumb of your free hand on the patientís upper
eyelid and lashes and draw the lid upward exposing the upper
edge of the shell.
Step 5. Placement of Suction Cup:
Set the suction cup flush against the front upper part of
the shell, and then release the squeezing. The suction
cup should be attached to the scleral shell.
Step 6. Removal of Scleral Shell:
The suction cup is then held lightly (so not to break the
suction). As the prosthesis is being drawn away from
the upper lid, have the patient look straight ahead so the
cornea will not come in contact with the lower edge of the
Method 2 - Removal Technique with the
Fingers: Although, not favored by this laboratory,
the scleral shell can be removed with the use of the index
fingernail and the thumb of the caregiver. The target
site for removal is the outer peripheral edge of the scleral
shell. Fortunately, for this technique, the scleral
shell prosthesis does not extend beyond the inner and outer
canthus, and can be located quite easily just by touch for
the visually impaired.
Have the patient look nasally, while you elevate their upper
eyelid with your thumb. Then, with the other hand,
draw the back of your index fingernail along the front of
the shell until you are able to catch hold of its outer peripheral
edge. Draw the shell away from the eye, so you can
grab it between the finger and thumb for quick removal.