Scleral rigid gas-permeable (RGP) lenses play an important and underappreciated role in the treatment of ocular surface disease. This review provides an update on scleral rigid gas-permeable lenses in the therapy of ocular surface disease (OSD). Several large cohort studies and case series have been published since 2008 that report on the use of scleral RGP lenses in the treatment of ocular surface disease as a sub-group of corneal disease, or in specific diseases such as Stevens-Johnson syndrome and ocular chronic graft-versushost disease. In addition, there are case reports detailing the treatment with scleral lenses in OSD of specific etiology such as herpes zoster, limbal stem cell deficiency or ocular cicatricial pemphigoid. Two case series were published showing innovative utility of scleral RGP lenses in the management of OSD after glaucoma surgery and for drug delivery for corneal neovascularization. Reports continue to emerge on the impact of scleral RGP lenses in the treatment of patients with ocular surface disease. Advances in lens design and fitting techniques make scleral RGP lenses a practical option for a rising number and variety of patients with corneal disease. Clinicians who treat patients with ocular surface disease should be aware of scleral RGP lenses as a method to treat OSD. J. Exp. Clin. Med., 2012; 29:S50-S54