Dry Eye Disease is the most frequent reason that patients visit eye doctors. We are concerned that
you may be suffering with this condition as well. Therefore, we ask that you take a few moments
and thoughtfully complete the questionnaire below.
Report the FREQUENCY of dry eye symptoms you are experiencing by checking Never,
Sometimes, Often or Constant using the SYMPTOMS system below:
Dryness, Grittiness or Scratchiness
Soreness or Irritation
Burning or Watering
Report the SEVERITY of your symptoms using the ratings list below:
Please choose when did you experienced symptoms:
Have you been told that you have blepharitis or have you been treated for a stye?
Do you have fluctuating vision problems? (That can be corrected with blinking)