Dry eye quiz Dry Eye Severity 1. Do you have any of the following symptoms?Dryness, Grittiness or ScratchinessYesNoSoreness or IrritationYesNoBurning or Watery EyesYesNoEye FatigueYesNo2. If "yes" do symptoms occur often?YesNo3. Do symptoms ever interfere with your day?YesNo4. Have you ever used eyedrops for lubrication?YesNo5. Do you ever have any of these allergy symptoms?Itchy Eyes, Watery Eyes, Red Eyes, Dark Circles Under Eyes, Swollen Eyes, Asthma, Itchy Skin, Runny Nose, Congestion, Flaky/Red SkinYesNo You may have Mild to Moderate Dry Eyes An evaluation by one of our doctors can help ensure your symptoms don’t worsen.You may have Moderate to Severe Dry Eyes Our doctors can test your tear quality, determine the cause, and select a more effective treatment plan for longer term relief of your symptoms.Allergy Symptoms If you answered “yes” to this question our comprehensive allergy testing can determine if your symptoms are related to dry eye disease. Would you like to send your score so that we may contact you?First NameLast NameEmail Address PhoneBest Time to CallAdditional Information
