Gulf Coast Eye Care

Dry Eye Self Evaluation Test

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Dry Eye Self Evaluation 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 numbering system below:
0 = Never, 1 = Sometimes, 2 = Often, 3 = Constant

Symptoms


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

0 = No problems
1 = Tolerable - not perfect but not uncomfortable
2 = Uncomfortable - irritating but does not interfere with my day
3 = Bothersome - irritating and interferes with my day
4 = Intolerable - unable to perform my daily tasks

Symptoms

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

Visit our Dry Eye page for more information on symptoms and treatment.

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