How can I protect my eye that can't close due to Bell's Palsy or Facial Nerve damage? Scleral Lenses.

When an eye cannot close all the way, even sleep can become painful. Air reaches the cornea hour after hour. Tears evaporate too quickly. Drops help for a few minutes, but the relief often fades before the eye has a chance to heal.

This is a common struggle for people with Bell’s palsy or facial nerve damage. When the eyelid does not blink or seal normally, the exposed surface of the eye can dry out, become inflamed, and develop damage. Scleral lenses offer a different kind of protection: a smooth lens that vaults over the cornea and holds a layer of sterile saline against the eye while it is worn.

A scleral lens creates a fluid reservoir that can protect an exposed cornea.

Why Bell’s palsy and facial nerve damage can threaten the cornea

The cornea is the clear front window of the eye. It needs a stable tear film and regular blinking to stay healthy. Blinking spreads tears, clears debris, and helps the eyelids protect the cornea during sleep.

Bell’s palsy and other forms of facial nerve damage can interrupt this system. The eyelid may not close completely, a condition often called lagophthalmos. Some people also blink less often or with less force. Over time, the exposed cornea can develop dryness, irritation, light sensitivity, blurred vision, and in more serious cases, abrasions or ulcers.

For people searching for Bell's Palsy related dry eye or exposure keratitis, corneal scarring is one of the most important risks to understand. Scarring can affect the clarity of the cornea. When light can no longer pass cleanly through it, vision may become hazy, distorted, or reduced.

Traditional care may include lubricating drops, ointments, moisture chambers, eyelid taping, or surgical procedures in some cases. These can help. But for many people, especially those who need daytime visual clarity and long-lasting comfort, scleral lenses can fill an important gap.

How scleral lenses create steady moisture and protection

A scleral lens is larger than a standard soft contact lens. Instead of resting on the cornea, it lands on the white part of the eye, called the sclera. The center of the lens arches over the cornea, leaving space for a reservoir of preservative-free saline.

That fluid layer is the key. It acts like a continuous cushion of moisture while the lens is on the eye.

Scleral lenses can help by:

• Keeping the cornea bathed in fluid for many hours

• Shielding the eye from air exposure

• Reducing friction from incomplete blinking

• Protecting healing tissue from the eyelid and environment

• Creating a smoother optical surface for clearer vision

  
  

Preventing corneal scarring and improving vision

Dryness alone is uncomfortable. Exposure-related dryness can become more serious because it may injure the corneal surface. Once the surface breaks down, the eye becomes more vulnerable to infection, inflammation, and scarring.

Scleral lenses help reduce that risk by covering the cornea with a stable protective barrier. The lens does not let air directly strike the corneal surface. The fluid reservoir helps keep fragile tissue moist. This can support healing and may reduce the chance of repeated surface breakdown.

Vision can also improve for a practical reason. A dry, irregular tear film scatters light. If the cornea has surface irregularity from dryness or prior injury, vision can fluctuate throughout the day. The smooth front surface of a scleral lens and the fluid underneath can mask some irregularities, giving light a cleaner path into the eye.

Patients often describe this as less “foggy,” less “scratchy,” or more stable vision. The goal is not only comfort. The goal is to preserve the health of the cornea so the eye has the best chance to see clearly.

Comfort matters because the lens has to work in real life

A protective device only helps if it can be worn consistently. Comfort is one reason scleral lenses are so useful for exposure-related eye problems.

Because the lens rests on the sclera rather than the sensitive cornea, many people find it surprisingly comfortable once they learn insertion and removal. The lens can also reduce the constant awareness of dryness, burning, or a foreign-body feeling.

How Cohenmehr Eye fits scleral lenses for complex dry eye

At Cohenmehr Eye, advanced fitting techniques focus on comfort, stability, and corneal protection. Our Los Angeles scleral lens expert, Dr. Brandon Cohenmehr even published a case report discussing early use of scleral lenses for a patient who was unable to create tears (see below)

The process may include detailed evaluation of the ocular surface, tear film, eyelid closure, and corneal health.

Cohenmehr Optometry scleral lens fitting often uses tools such as corneal topography, anterior segment OCT, scleral profilometry, and slit lamp biomicroscopy. These measurements help guide the design so the lens vaults the cornea without pressing on it. The edge of the lens is also adjusted to sit comfortably on the sclera.

The fitting process often includes follow-up visits. That is where small changes can make a major difference. A slight adjustment in diameter, edge shape, vault, or prescription can improve wear time and reduce midday fogging. Patient education is part of the care as well, including safe cleaning, filling, insertion, removal, and when to call the office.

Real-world outcomes patients often describe

Every eye is different, and no single treatment works for everyone. Still, the patterns patients report after successful scleral lens fitting are meaningful.

One composite case involves an adult who developed incomplete eyelid closure after facial nerve injury. Before scleral lenses, the person relied on drops many times a day and still had burning, redness, and blurred afternoon vision. After a careful fitting process and a few design adjustments, the patient could wear the lens through most waking hours, with fewer dryness spikes and more stable vision.

Another composite case involves someone recovering from Bell’s palsy who had persistent exposure symptoms in one eye. The person felt anxious about corneal damage and had trouble reading for long periods. With a scleral lens, the eye stayed more comfortable during daily tasks. The patient still used nighttime protection, but daytime function improved.

Common patient-reported benefits include:

• Less burning and grittiness

• Better tolerance of wind, screens, and dry indoor air

• Clearer, steadier vision

• Fewer interruptions for lubricating drops

• More confidence that the cornea is protected

  
  

A protected cornea can change the day

Living with an eye that will not close fully can feel relentless. The discomfort is physical, but the worry is emotional too. Vision matters. Sleep matters. The ability to read, work, drive, and move through the day without constant burning matters.

Scleral lenses do not cure Bell’s palsy or facial nerve damage. They can, though, provide what exposed eyes often need most: steady moisture, a protective barrier, and clearer optics. With careful fitting and ongoing care, they can help reduce the risk of corneal injury while making daily life more comfortable.

For anyone dealing with persistent exposure dryness, a scleral lens evaluation can be a practical next step toward protecting the eye and restoring a sense of relief.

Brandon Aaron Cohenmehr, OD

Scleral Lens and Dry Eye Expertise

Call 310-828-2010 to schedule your consultation at Cohenmehr Eye, an advanced scleral lens center in Los Angeles.

Appointments can also be scheduled at www.cohenmehreye.com