Depuis 2012
This questionnaire helps assess the severity of your dry eye symptoms
Please indicate whether you experienced any of the following symptoms during the past week by selecting one response for each question.
Left: None of the time | Right: All of the time
1- Sensitivity to light during the past week ?
2- Gritty, sandy or itchy sensation during the past week ?
3- Burning or stinging during the past week ?
4- Blurred or unclear vision during the past week ?
5- Vision that fluctuates with blinking during the past week ?
6- Vision that improves with artificial tears during the past week ?
7- Tearing or watery eyes during the past week ?
8- Pain or burning during the night or upon waking in the morning during the past week ?
9- Reading or driving for extended periods during the past week ?
10- Watching television or working on a computer for an extended period during the past week ?
11- When exposed to wind or drafts during the past week ?
12- In low-humidity environments, such as heated or air-conditioned spaces or airplanes, during the past week ?
1- How much do your eyes bother you ?
2- What brand of artificial tears do you use ?
3- How often do you use artificial tears ?
4- Compared with your last visit, are your symptoms better, the same or worse ?
Légende
Complete the information below so that our team can follow up with you.
