Ocular Surface Disease Index (OSDI)

Evaluating the OSDI Score

Ocular Surface Disease Index (OSDI)

Please answer the following 12 questions and select the applicable number in the box that best represents each answer.
Name

First NameLast Name

Have you experienced any of the following during the last week?*

Have problems with your eyes limited you in performing any of the following during the last week?*

Rows	All of the time- 4	Most of the time- 3	Half of the time- 2	Some of the time- 1	None of the time- 0	N/A
6. Reading?
7. Driving at night?
8. Working with a computer or bank machine (ATM)?
9. Watching TV?

Have your eyes felt uncomfortable in any of the following situations during the last week?*

Rows	All of the time- 4	Most of the time- 3	Half of the time- 2	Some of the time- 1	None of the time- 0	N/A
10. Windy conditions?
11. Places or areas with low humidity (very dry)?
12. Areas that are air conditioned?

Total
Evaluating the OSDI Score
The OSDI is assessed on a scale of 0 to 100, with higher scores representing greater disability. The index demonstrates sensitivity and specificity in distinguishing between normal subjects and patients with dry eye disease.

This is a valid and reliable instrument for measuring dry eye disease (normal, mild to moderate, and severe) and effect on vision-related function.
Grand Total
This total indicates your OSDI Score which is measured against the following diagram.
Our practitioner will assess these results and discuss them with you at your appointment.

Thank you for completing this form.
Should be Empty:

All of the time- 4

Most of the time- 3

Half of the time- 2

Some of the time- 1

None of the time- 0

1. Eyes that are sensitive to light?

2. Eyes that feel gritty?

3. Painful or sore eyes?

4. Blurred vision?

5. Poor vision?