Insertion of Scleral Trial Shell or
Prosthesis Over a Dysfunctional Globe
(Instructions for Caregiver)
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 irritation.
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.
- 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 is top):
Grasp 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
- 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 hold.
- 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 is irritated.