Dry Eye Quiz

Published August 30, 2020

Are you suffering from dry eyes? 

This questionnaire will allow you to record the frequency and severity of your dry eye symptoms, and help your doctor to determine what is causing your dry eyes.

Please print out this page and circle your answers below.

Part 1: Please circle the FREQUENCY of your symptoms on a scale of 0-3

(0= Never, 1= Sometimes, 2= Frequent, 3= Always)

  1. Dryness, grittiness, or scratchiness 0 1 2 3
  2. Soreness or irritation 0 1 2 3
  3. Burning or watering 0 1 2 3
  4. Eye fatigue 0 1 2 3

Part 2: Please circle the SEVERITY of your symptoms on a scale of 0-4

(0= Unnoticeable, 1= Not too uncomfortable, 2= Uncomfortable, 3= Irritating, 4= Unbearable)

  1. Dryness, grittiness, or scratchiness 0 1 2 3 4
  2. Soreness or irritation 0 1 2 3 4
  3. Burning or watering 0 1 2 3 4
  4. Eye fatigue 0 1 2 3 4

Part 3: Add up all the circled numbers for your final score: ________

What does your final score mean?

Did you score above 8* points?

If you did, it is recommended to schedule an appointment with your eye doctor for a thorough evaluation of your symptoms, and to obtain an effective treatment plan.

*Published in Cornea (2013).