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Dry Eye Self Test


  1. How often do you have redness?
  2. How often do you have sandy or gritty sensation?
  3. How often do you have itching?
  4. How often do you have excess watering?
  5. How often do you have burning?
  6. How often do you have excess mucous?
  7. How often do you have blurred vision?
  8. Are your eyes sensitive to smoke?
  9. Are your eyes sensitive to light?
  10. Are your eyes sensitive to air pollution?
  11. Are your eyes sensitive to wind?
  12. Are your eyes sensitive to heaters?
  13. Are your eyes sensitive to air conditioning?
  14. Are your eyes sensitive to contact lenses?
  15. How often do you use anti depressants?
  16. How often do you use redness reducing eye drops?
  17. How often do you use decongestants?
  18. How often do you use antihistamines?
  19. How often do you use blood pressure medication?
  20. How often do you use artificial tear drops?
  21. How often do you use hormones?
  22. How often do you use oral contraceptives?
  23. How often do you use diuretics?
  24. How often do you use ulcer medication?
  25. How often do you use tranquilizers?
  26. How often do you use beta blockers?
  27. How often do you use incontinence therapies?
  28. Average daily computer time hours ?
  29. Have you ever been diagnosed with thyroid abnormalities?
  30. Have you ever been diagnosed with rheumatoid arthritis?
  31. Have you ever been diagnosed with asthma?
  32. Have you ever been diagnosed with diabetes?
  33. Have you ever been diagnosed with glaucoma?
  34. Are you over 45?
  35. Are you post-menopausal?
  36. Are you considering refractive surgery?
  37. Do you experience contact lens discomfort?
  38. Do you get eyestrain?
  39. Do you blink your eyes excessively?
  40. As an adult, have you had blemishes on your face?

*If your scored 30 or higher you may have dry eyes. Please call our office for an evaluation

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