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