Dry Eye Self Test
- How often do you have a sandy gritty sensation? Never, sometimes, frequently, always
- How often do you have redness? Never, Sometimes, Frequently, always
- How often do you have itchy eyes?
- How often do you have excess watering?
- How often do you have burning?
- How often do you have excess mucous?
- How often do you have blurry vision the clears after blinking?
- Are you light sensitive? Yes or no
- Are your eyes sensitive to wind? Never, Sometime, Frequently, Always
- Are your eyes sensitive to contact lenses? Never, Sometimes, Frequently, always
- How often do you use redness reducing eye drops? Never, Sometimes, Frequently, always
- Do you smoke? Never, Sometimes, Frequently, always
- Do you take oral contraceptives, anti depressants, antihistamines or decongestants? Mark the circle that applies
- Do you have High blood pressure?
- Do you have Diabetes?
- Do you have an autoimmune condition?
- Do you take hormone pills?
- Have you been diagnosed with thyroid abnormalities?
- Average Daily Computer use? 0 hours, 1-2 hours, 2-4 hours, over 4 hours
- Have you been diagnosis with an eye condition or eye surgery? Please list
