Dry Eye Questionnaire

Dry Eye Questionnaire

Dry Eye Questionnaire

Dry Eye Questionnaire

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

Eyes that are sensitive to light

Eyes that feel gritty

Painful or sore eyes

Blurred vision

Poor vision

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

Reading

Driving at night

Working with a computer or bank machine (ATM)

Watching TV

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

Windy conditions

Places or areas with low humidity (very dry)

Areas that are air conditioned

First Name

Last Name

Email

Phone

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