Dry Eye Quiz Dry Eye Quiz Name* First Last Email* PhoneHow often do you experience redness in your eyes? Never Rarely Often Always How often do you experience a sandy/girtty sensation? Never Rarely Often Always How often do you experience excessive water/mucus? Never Rarely Often Always How often do you experience burning sensation? Never Rarely Often Always How often do you experience blurry vision? Never Rarely Often Always Are your eyes sensitive to light? Never Rarely Often Always Are your eyes sensitive to wind? Never Rarely Often Always Are your eyes sensitive to computer screens? Never Rarely Often Always Are your eyes sensitive to heat? Never Rarely Often Always Are your eyes sensitive to contact lenses? Never Rarely Often Always Do you ever experience eye strain? YES NO Do you blink your eyes excessivley? YES NO Do you use over the counter drops or ointments? YES NO If YES, how often? Rarely 1-2 times per day 3-4 times per day 5 or more per day
