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
Step 2. The Eye Position:
Set a mirror at an angle so you are looking downward to see your image. (The scleral shell will also be in a downward position.)
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 your index, forefinger or thumb (whichever is more comfortable, and does not obstruct your vision) of your free hand on the upper lid and eyelashes. Pull the eyelid toward the eyebrow. This should expose the upper edge of the scleral 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). The prosthesis is then pulled away from the eye and the upper eyelid in one quick motion as you return to a frontal gaze.
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 wearer. 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.
Tip your head downward, while spreading your eyelids apart with the thumb and forefinger of one hand. Look nasally, then with the other hand, draw the back of the index fingernail across the front of the shell until it is in contact with the temporal peripheral edge of the scleral shell. Slide the fingernail past the edge and draw the shell away from the eye. Gravity should help it slip out, if not you may have to use the thumb to grab the shell.