Dry Eye Quiz Step 1 of 10 10% How often do you experience the following symptoms?Dryness:(Required)NeverSometimesOftenConstantGrittiness/Scratchiness:(Required)NeverSometimesOftenConstantBurning/Soreness/Irritation:(Required)NeverSometimesOftenConstantWatering:(Required)NeverSometimesOftenConstantEye Fatigue:(Required)NeverSometimesOftenConstant How severe are the following symptoms?Dryness:(Required)NoneTolerableUncomfortableBothersomeIntolerableGrittiness/Scratchiness:(Required)NoneTolerableUncomfortableBothersomeIntolerableBurning/Soreness/Irritation:(Required)NoneTolerableUncomfortableBothersomeIntolerableWatering:(Required)NoneTolerableUncomfortableBothersomeIntolerableEye Fatigue:(Required)NoneTolerableUncomfortableBothersomeIntolerable Do you use drops or ointment regularly?(Required) Yes No If yes, what products do you use?How long the drops or ointments are effective? Have you been diagnosed with blepharitis of stye?(Required) Yes No What age are you?(Required) 5-20 21-40 41-60 61-80 81+ Do you experience the following symptoms?(Required) Blurriness Burning Dryness Irritation Itchy Eyes Pain Red Eyes Stinging Watery Eyes How severe are your symptoms?(Required) Awareness Tolerable Uncomfortable Bothersome Severe When did you last experience these symptoms?(Required) Today Last 72 Hours Within the last 3 Months Longer than 3 months Have you used any of the following to ease your Dry Eye Symptoms?(Required) Artificial Tears Warm Compress Mask Dry Eye Technology Light therapy Lipiflow Punctal Plugs Dry Eye Prescription drops Please provide your information where we will deliver your results to you!First Name(Required) First Name Last Name(Required) Last Name Email(Required) Phone(Required) Δ
