Corneal ectasias, including keratoconus (KC), pellucid marginal degeneration (PMD), and post-LASIK ectasia, poses significant visual rehabilitation challenges due to the resultant irregular astigmatism, myopia, and higher-order aberrations (HOAs). These conditions often resist traditional corrective methods, necessitating advanced optical solutions. Scleral lenses (SLs) have emerged as a primary non-surgical option for managing these complex corneal irregularities. SLs form a smooth optical interface by forming a tear-filled chamber between the lens and the cornea, effectively mitigating HOAs and improving both high-contrast and low-contrast visual acuity (VA). This review evaluates the efficacy of SLs in enhancing VA and reducing aberrations in patients with corneal ectasia. It also explores the technological advancements in SLs, such as profilometry and wavefront-guided systems, which enable more precise and customized lens fittings by accurately mapping the eye’s surface and addressing specific visual aberrations. The current body of evidence demonstrates that custom SLs significantly improve visual outcomes across various ectatic conditions, offering superior performance compared to conventional correction methods. However, challenges such as the complexity of fitting and the need for precise alignment remain. Ongoing innovations in SL technology and customization are likely to further enhance their clinical utility, solidifying their role as an indispensable tool in the management of corneal ectasias.

Purpose: Dry eye disease (DED) is a multifactorial condition significantly impacting patients’ quality of life (QoL). This study aims to present a case series highlighting the effectiveness of customized scleral lenses in managing severe DED and improving patient outcomes. Methods: This case series includes three patients with severe DED refractory to conventional treatments. Customized scleral lenses were fitted for each patient, and clinical outcomes were evaluated over a period of two months. Assessments included best-corrected visual acuity (BCVA), slit-lamp examination findings, and corneal National Eye Institute (NEI) scores. Results: All three patients demonstrated significant improvements in BCVA, reductions in ocular symptoms, and enhanced ocular surface health. Patient 1, with secondary Sjögren’s syndrome and suspected mucous membrane pemphigoid, showed resolution of conjunctival hyperemia and epithelial defects. Patient 2, with graft versus host disease, exhibited resolution of punctate keratitis and the absence of thread mucus. Patient 3, post-oncologic surgery, achieved complete resolution of keratoconjunctivitis sicca and the restoration of vision. Conclusions: Customized scleral lenses are a useful therapeutic option for severe DED, providing significant symptomatic relief and enhancing patients’ quality of life. Their use should be considered in refractory cases to optimize ocular surface health and visual outcomes.

Background/Objectives: Cataract surgery has evolved into a refractive procedure aimed at optimizing both vision quality and quantity. Modern patients, particularly “baby boomers”, expect superior outcomes, increasing demand for premium intraocular lenses (IOLs). However, ocular surface dysfunction (OSD), especially dry eye disease (DED), compromises postoperative satisfaction, with up to 35% of patients dissatisfied despite achieving 20/20 visual acuity. This study aimed to characterize postsurgical ocular surface system failure (OSSF) and explore strategies to improve perioperative management. Methods: An open observational study was conducted at the Ophthalmology Complex Operative Unit, University Campus Bio-Medico, Rome, Italy, enrolling 20 patients with stage N2–3 and C1–2 lens opacities. Patients with diabetes, prior surgeries, or ocular inflammatory diseases were excluded. Preoperative and postoperative assessments included OSDI, SANDE scores, Schirmer test, TBUT, and fluorescein staining. Follow-ups occurred at 1 week, 1 month, and 3 months postoperatively. Statistical analysis used two-way ANOVA (p < 0.05). Results: Despite achieving a BCVA of 20/20, 44% of patients reported OSSF symptoms. Postoperative evaluations revealed significant worsening in OSDI and SANDE scores (p < 0.001), Schirmer test (preoperative mean 19.92 ± 10.06; p < 0.001), and TBUT (preoperative mean 5.88 ± 2.64 s; p < 0.001). Meibomian gland dysfunction and conjunctival hyperemia also worsened. Conclusions: Postsurgical OSSF results from neurogenic inflammation, tear film instability, and meibomian gland dysfunction, exacerbated by surgical trauma. Preoperative and postoperative management, including artificial tears, lid hygiene, and preservative-free regimens, are essential to improve outcomes and patient satisfaction. Comprehensive strategies can mitigate symptoms and enhance the benefits of cataract surgery.