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Dry Eye Syndrome Evaluation Tool

 
  Y S N
Do your eyes feel gritty or scratchy?
Do your eyes feel like they're stinging or burning?
Are your eyes watery or red?
Do you take hormone replacement therapy or are post-menopausal?
Do you wear contact lenses?
Do you work at a computer or watch television for long periods?
Are your eyes sensitive to light or dust?
Do you wake up with mucus around your eyelids?
Are your eyes itchy, especially around the corners?
Do you suffer from blurry vision that changes when you blink?
Do you suffer from athritis, asthma or gout?
Do you take antidepressants or corticosteroids?
Do you take diuretics or antihistamines?
Are you over 40 years of age?  
 

This information will be collected for educational purposes, however it will remain anonymous.

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Please be aware that we do not give advice on your individual medical condition,
if you want advice please see your treating physician.

Information on this site must be discussed with your treating doctor.

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