Removal of Scleral Trial Shell or Prosthesis
from a Corneal Sensitive Globe
(Instructions for Patient)
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:
Set a mirror at an angle so you are looking downward to see
your image. (The scleral shell will also be in 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 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.