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Take this questionnaire to rate
the degree of your dry
eye symptoms.

Simply respond to the 14 questions by
choosing the answer that best describes
your current situation.
Start Test
What is your gender?
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Which one of the following age groups do you fall into?
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Have you experienced EYES THAT ARE SENSITIVE TO LIGHT over the last week?
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Have you experienced EYES THAT FEEL GRITTY over the last week?
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Have you experienced PAINFUL OR SORE EYES over the last week?
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Have you experienced BLURRED VISION over the last week?
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Have you experienced POOR VISION over the last week?
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Did you have problems with your eyes when READING over the last week?
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Did you have problems with your eyes when DRIVING AT NIGHT over the last week?
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Did you have problems with your eyes when USING A COMPUTER OR A BANK MACHINE (ATM) over the last week?
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Did you have problems with your eyes when WATCHING TV over the last week?
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Have your eyes felt uncomfortable in WINDY CONDITIONS over the last week?
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Have your eyes felt uncomfortable in PLACES OR AREAS WITH LOW HUMIDITY (VERY DRY ENVIRONMENTS) over the last week?
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Have your eyes felt uncomfortable in PLACES THAT ARE AIR CONDITIONED over the last week?
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