North Toronto Optometry

Dry Eye Test

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

Eye Fatigue

Report the SEVERITY of your symptoms using the ratings list below:

Dryness, Grittiness or Scratchiness

Soreness or Irritation

Burning or Watering

Eye Fatigue

Please choose when did you experienced symptoms:

Have you been told that you have blepharitis or have you been treated for a stye?

Blepharitis

Stye

Do you have fluctuating vision problems? (That can be corrected with blinking)