There was a rapid development of a very protrusive globic type corneal profile lead to significant visual loss over a four year period leaving no worthwhile improvement with spectacles. Rigid corneal lens fitting was unsuccessful due to discomfort and instability of the lens in situ. The other eye had developed hydrops, which had more or less resolved, but refitting with contact lenses had been postponed. The profile was much the same as the right eye, having a similar outcome with corneal lenses prior to the hydrops episode.

A Scleral lens was suggested as a final option before a transplant. The idea was immediately taken up by the patient who did not want an eye operation if there was a feasible alternative. A sealed RGP scleral lens was fitted clear of the cornea at the visual axis and a glancing contact at the cone apex. Following issue, he built up to all day wear within one week. Visual acuity was 6/9. To date, the lens has been worn trouble free for 24 months.