Dry Eye Self Evaluation Quiz | Cincinnati Eye Institute

Question 1: What is your age?

Under 18

19 - 39

40 - 59

60+

Question 2: Are you currently using artificial tears, heat masks and/or specific lid hygiene?

Yes

Question 2.1: If yes, do they provide any improvement in symptoms?

Yes

Question 3: Do any of the above symptoms affect the following? Please check all that apply.

Driving

Reading

Watching TV

Using a computer, smartphone or tablet

Question 4: How often do your eyes bother you?

Rarely

Sometimes

Often

Constantly

Question 5: How severe would you rate the symptoms above, on average?

No problems

Tolerable (not perfect, but not uncomfortable)

Uncomfortable (irritating but doesn’t interfere with my day)

Bothersome (irritating and interferes with my day)

Intolerable (unable to perform daily tasks)

Question 6: Do your dry eyes seem to be getting worse?

Yes

Question 7: Would you be interested in scheduling an Appointment for further evaluation?

Yes, please contact me!

Maybe down the road

Finalize Your Evaluation

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Suffering With Dry and Irritated Eyes?

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