We evaluated the use of a highly gas-permeable, fluid-filled scleral lens for patients with diseased corneas for whom conventional contact lens strategies failed. Fifteen patients were successfully fit with individually fabricated scleral lenses. Significant corneal hypoxia, which limited the use of previous polymethylmethacrylate scleral lenses, was not encountered. Preliminary results suggest that a gas-permeable scleral lens may offer therapeutic as well as visual benefit to some patients with severe corneal disease.