Do you have dry eye ?

Symptoms of dry eye include burning, itching and watery eyes. This 12 point questionnaire will grade your symptoms and provide an indication of whether you have dry eye.

In the past week, how often have you experienced eyes that are sensitive to light ?
In the past week, how often have you experienced eyes that feel gritty ?
In the past week, how often have you experienced painful or sore eyes ?
In the past week, how often have you experienced blurred vision ?
In the past week, how often have you experienced poor vision ?
Have problems with your eyes limited you when READING during the past week ?
(Please leave blank if not applicable)
Have problems with your eyes limited you when DRIVING AT NIGHT during the past week ?
(Please leave blank if not applicable)
Have problems with your eyes limited you when WORKING WITH A COMPUTER during the past week ?
(Please leave blank if not applicable)
Have problems with your eyes limited you when WATCHING TV during the past week ?
(Please leave blank if not applicable)
Have your eyes felt uncomfortable in WINDY CONDITIONS during the past week ?
(Please leave blank if not applicable)
Have your eyes felt uncomfortable in PLACES WITH LOW HUMIDITY (VERY DRY AIR) during the past week ?
(Please leave blank if not applicable)
Have your eyes felt uncomfortable in AIR CONDITIONED SPACES during the past week ?
(Please leave blank if not applicable)

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