Visual and Therapeutic Outcomes of Scleral Lens in Pediatric Ocular Surface Diseases

To evaluate the long-term visual and therapeutic outcomes of scleral lenses in pediatric patients with ocular surface disorders over a 17-year period at a tertiary eye care center.

This retrospective observational study included pediatric patients (≤18 years) with ocular surface disorders who underwent scleral lens fitting between 2008 and 2025 at a tertiary center in South India, with a minimum follow-up of 12 months. Data extracted from electronic medical records included demographics, diagnosis, best-corrected visual acuity (BCVA), corneal neovascularization, surface keratinization, lubricant dependence, prior surgeries, and lens-related complications. Corneal neovascularization and keratinization were graded on a 0 to 3 scale. Snellen BCVA was converted to logMAR for analysis. Primary outcomes were change in visual acuity and ocular surface parameters.

Ninety-one eyes of 67 pediatric patients (45 males, 22 females) were analyzed. Mean age at lens insertion was 10.63 ± 3.23 years (range 4-17), with mean follow-up of 40.0 ± 22.32 months. Among eyes with chemical injury, 10/14 had prior simple limbal epithelial transplantation, whereas 22/75 eyes with Stevens-Johnson syndrome underwent symblepharon release before fitting. BCVA improved significantly (P < 0.05) after lens fitting. Corneal neovascularization decreased in 73% of eyes, lubricant dependence reduced in 41.8%, and 66.7% of SJS eyes showed reduced keratinization. Complications included conjunctival impingement (12%) and lens breakage (2.2%); no lens-related infections occurred.

Scleral lenses provide safe, sustained visual improvement and ocular surface stabilization in pediatric ocular surface disease and should be considered an integral component of multidisciplinary care.