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Dry Eye Doctor

Expert treatment for dry, tired eyes

Treatments
Causes
Assessment
- Dry Eye Assessments
- Test Yourself for Dry Eye
Prices
Contact
- Patients
- Health Professionals
About Us

Treatments
Causes
Assessment
- Dry Eye Assessments
- Test Yourself for Dry Eye
Prices
Contact
- Patients
- Health Professionals
About Us

Dry Eye Questionnaire

Please complete the following dry eye questionnaire. The OSDI (Ocular Surface Disease Index) has been scientifically validated to effectively screen for dry eye.

Have you experienced any of the following during the last week?
Eyes sensitive to light?*
- None of the time
- Some of the time
- Half of the time
- Most of the time
- All of the time
Eyes that feel gritty?*
- None of the time
- Some of the time
- Half of the time
- Most of the time
- All of the time
Painful or sore eyes?*
- None of the time
- Some of the time
- Half of the time
- Most of the time
- All of the time
Blurred vision?*
- None of the time
- Some of the time
- Half of the time
- Most of the time
- All of the time
Poor vision?*
- None of the time
- Some of the time
- Half of the time
- Most of the time
- All of the time
Hidden
Total A
Have problems with your eyes limited you in performing any of the following during the last week?
Reading?*
- None of the time
- Some of the time
- Half of the time
- Most of the time
- All of the time
- Not applicable
Hidden
NA6
Driving at night?*
- None of the time
- Some of the time
- Half of the time
- Most of the time
- All of the time
- Not applicable
Hidden
NA7
Working with a computer or bank machine (ATM)?*
- None of the time
- Some of the time
- Half of the time
- Most of the time
- All of the time
- Not applicable
Hidden
NA8
Watching TV?*
- None of the time
- Some of the time
- Half of the time
- Most of the time
- All of the time
- Not applicable
Hidden
NA9
Hidden
Total B
Have your eyes felt uncomfortable in any of the following situations during the last week?
Windy conditions?*
- None of the time
- Some of the time
- Half of the time
- Most of the time
- All of the time
- Not applicable
Hidden
NA10
Places or areas with low humidity (very dry)?*
- None of the time
- Some of the time
- Half of the time
- Most of the time
- All of the time
- Not applicable
Hidden
NA11
Areas that are air conditioned?*
- None of the time
- Some of the time
- Half of the time
- Most of the time
- All of the time
- Not applicable
Hidden
NA12
Hidden
Total C
Hidden
Total A+B+C
Hidden
Total NA Responses
Total Answered
OSDI Value
The results indicate you have severe dry eye.

Why not book an appointment?
The results indicate you have moderate dry eye.

Why not book an appointment?
The results indicate you have mild dry eye.

Why not book an appointment?
Great, you don't have dry eye!
Email
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Last name*
Email*
Telephone
When would you like to request this appointment?*
DD slash MM slash YYYY
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