The flush-fitting scleral shell is used to cover a blind, unsightly eye that has not otherwise
deteriorated to a condition that requires enucleation. Phthisis bulbi, (shrinking of the eye)
is a common reason for the fitting of a flush-fitting scleral shell.
They also provide a smooth
surface for the eye lids to close over thereby improving comfort for the patient. Flush fitting
shells are very thin compared to regular ocular prostheses and require precise fitting to achieve
The patient is usually fitted with a clear flush-fitting trial shell made from a direct
impression of the eye. Instructions are given to the patient on how to insert and remove the trial lens and
a wearing schedule is provided. Normally the wearing schedule is prescribed over a two-week
period adding more wearing time with each passing day.
In the majority of cases, patients
become very comfortable with the scleral shell in a very short time. The most important consideration
for most patients, is to be able to wear the shell while in public and during normal waking hours.
If necessary however, the ophthalmologist can resolve a discomfort problem with a minor in office
procedure called a Gunderson Flap. This procedure draws a membrane of conjunctiva over the
sensitive cornea so once healed, wearing a shell a usually well tolerated.
When the shell can be comfortably worn, a white plastic scleral shell of the same shape is
manufactured and hand painted to match the details of the companion eye.
This type of shell usually
provides an excellent result and improved patient comfort. A carefully crafted scleral shell not
only looks like the other eye, it usually moves in a synchronous manner with the other eye.
In addition to the improved appearance and increased comfort, the flush fitting
scleral shell provides a more natural surface for normal lachrimal tear function.
The average cost of a sclera shell in the United
States is $2,500 to $3,000 and in most cases is
covered by insurance including Medicare.