Dry eye has many different treatment options. Some of the first treatments include artificial tears, punctal plugs, Restasis, and Xiidra. However, when these treatments do not work, we may also try autologous serum tears, Lacrisert, moisture goggles, and contact lenses. In dry eye, the surface of the cornea does not usually receive enough tears. This may be a distribution problem: the eye does not blink well so the tear film is not evenly distributed over the surface, or more commonly, it is due to a reduction in the overall tear volume. If the quality of the tear film is good, we can try to wet the eye with many of the agents previously described. However, that is frequently not enough, and a contact lens can be used. As shown in the diagram, the contact rests over the layer of the eye called the cornea. Due to surface tension, a layer of tears is held underneath the contact lens. This layer of tears is maintained resulting in increased moisture to the cornea. The contact lens also protects the surface of the eye from the eyelids. The eyelids can cause significant irritation because of the constant opening and closing on top of an already irritated surface. The contact also reduces evaporation because the silicone hydrogel material does not allow evaporation through its surface. This first treatment is called a "bandage contact lens." There is no correction in the contact, and it is only used to medically treat the eye. Here at Reveal Eye Care & Surgery, we also fit scleral contact lenses. These are often the most successful lens for severe dry eye. Some of these types of lenses are the Prose and Jupiter lenses. These lenses have a firm surface so they correct the vision. Often, there are patients that have not been able to see for a significant time period, and the scleral lens can restore their vision. Most contacts rest on the cornea or clear part of the eye (the brown or blue part of the eye is under the cornea). Scleral lenses rest on the white part of the eye and extend over the central cornea. Since they do not rest on the cornea at all, they are safe and not irritating for the corneal surface. They also maintain a thick layer of tears on top of the corneal surface. These lenses will often be almost a miracle for those with severe dry eyes. As a corneal specialist, Dr. Aaker is well versed in using contact lenses (both scleral lenses and bandage contact lenses) in the treatment of dry eye. If you live in the Austin, Round Rock, Cedar Park, Georgetown, Temple, Central Texas, or Waco areas and would like an evaluation, please call our office at 512-686-1224.