A number of ocular or systemic conditions can result in severe anterior surface dryness. Unfortunately, severe dry eye can be a disabling issue that limits a person’s ability to perform normal activities of daily living. Example of conditions that can lead to severe dryness that would require scleral lenses as part of the management therapy include: Graft Versus Host Disease (GVHD), Stevens Johnson syndrome, Sjogren’s syndrome, neurotrophic keratitis, and dry eye.