Removal of Scleral Trial Shell or Prosthesis from a Corneal Sensitive Globe
(Instructions for Caregiver)

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

1. 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.
2. 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:

Have the patient look downward.  This will allow most of the cornea and the conforming shell to show a downward gaze.

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 the thumb of your free hand on the patient’s upper eyelid and lashes and draw the lid upward exposing the upper edge of the 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).  As the prosthesis is being drawn away from the upper lid, have the patient look straight ahead so the cornea will not come in contact with the lower edge of the scleral shell.

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 caregiver.  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.

Have the patient look nasally, while you elevate their upper eyelid with your thumb.  Then, with the other hand, draw the back of your index fingernail along the front of the shell until you are able to catch hold of its outer peripheral edge.  Draw the shell away from the eye, so you can grab it between the finger and thumb for quick removal.

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