Dry Eye Questionnaire
Questions about Eye Discomfort:
During a typical day in the past month, how often did your eyes feel discomfort?
*
Never
Rarely
Sometimes
Frequently
Constantly
When your eyes felt discomfort, how intense was this feeling of discomfort at the end of the day, within 2 hours of going to bed?
*
Not at all Intense
0
1
2
3
4
Very Intense
5
0 is Not at all Intense, 5 is Very Intense
Questions about Eye Dryness:
During a typical day in the past month, how often did your eyes feel dry?
*
Never
Rarely
Sometimes
Frequently
Constantly
When your eyes felt dry, how intense was this feeling of dryness at the end of the day, within 2 hours of going to bed?
*
Not at all Intense
0
1
2
3
4
Very Intense
5
0 is Not at all Intense, 5 is Very Intense
Questions about Watery Eyes:
During a typical day in the past month, how often did your eyes look or feel excessively watery?
*
Never
Rarely
Sometimes
Frequently
Constantly
Name
*
First Name
Last Name
Email
example@example.com
Calculation
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