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Do you suffer with Dry Eye Syndrome?

Please answer the list of questions in this questionnaire to help us determine if you have dry eyes and if so how severe.

During the last week:
How often have your eyes felt sensitive to light?

All of the time Most of the time Half of the time Some of the time None of the time

During the last week:
How often have your eyes felt gritty?

All of the time Most of the time Half of the time Some of the time None of the time

During the last week:
How often have your eyes felt painful or sore?

All of the time Most of the time Half of the time Some of the time None of the time

During the last week:
How often have you experienced blurred vision?

All of the time Most of the time Half of the time Some of the time None of the time

During the last week:
How often have you experienced poor vision?

All of the time Most of the time Half of the time Some of the time None of the time

During the last week:
Have problems with your eyes affected you when READING?

All of the time Most of the time Half of the time Some of the time None of the time N/A

During the last week:
Have problems with your eyes affected you when DRIVING AT NIGHT?

All of the time Most of the time Half of the time Some of the time None of the time N/A

During the last week:
Have problems with your eyes affected you when USING A COMPUTER?

All of the time Most of the time Half of the time Some of the time None of the time N/A

During the last week:
Have problems with your eyes affected you when WATCHING TV?

All of the time Most of the time Half of the time Some of the time None of the time N/A

During the last week:
Have your eyes felt uncomfortable in WINDY CONDITIONS?

All of the time Most of the time Half of the time Some of the time None of the time N/A

During the last week:
Have your eyes felt uncomfortable in places or areas with LOW HUMIDITY (very dry)?

All of the time Most of the time Half of the time Some of the time None of the time N/A

During the last week:
Have your eyes felt uncomfortable in places or areas that are AIR CONDITIONED?

All of the time Most of the time Half of the time Some of the time None of the time N/A

During the last week:
Have your eyes been ITCHY?

All of the time Most of the time Half of the time Some of the time None of the time N/A

Thanks for answering the questions. Base on the results we have determined that you have 

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Our questionnaire is based on the Ocular Surface Disease Index (ODSI) questionnaire. It is used to indicate your degree of dry eye and is not definitive of your diagnosis.