Questions about EYE DISCOMFORT
During a typical day in the past month, how often did your eyes feel discomfort?
01234
When your eyes felt discomfort, how intense was this feeling of discomfort at the end of the day, within two hours of going to bed?
012345
Questions about EYE DRYNESS:
During a typical day in the past month, how often did your eyes feel dry?
When your eyes felt dry, how intense was this feeling of dryness at the end of the day, within two hours of going to bed?
Questions about WATERY EYES:
During a typical day in the past month, how often did your eyes look or feel excessively watery?
Score:
Score above 6 indicates dry eye symptoms.
1a
1b
2a
2b
3
TOTAL
Do you use eye drops or eye ointments?
YesNoSomtimes
Which drops or ointments do you use?
Only required if you wish to be contacted about your questionnaire results
Please contact me about my questionnaire results *
YesNo
Email
