Dry Eye Quiz

Free Dry Eye Quiz

Answer the following questions to better determine if you suffer from dry eye.

Vision Problem Symptom Checklist

Report the frequency of dryness, grittiness, and scratchiness
Report the frequency of soreness or irritation
Report the frequency of burning or watering
Report the frequency of eye fatigue
Report the severity of the following dry eye symptoms

Never = No Problems
Tolerable = Not Perfect, but not uncomfortable
Uncomfortable = Irritating but does not interfere with my day
Bothersome = Irritating and interferes with my day
Intolerable = unable to perform my daily tasks

Report the severity of dryness, grittiness, or scratchiness
Report the severity of soreness or irritation
Report the severity of burning or watering
Report the severity of eye fatigue
Please indicate when you last experienced any of these dry eye symptoms

This question is required.*
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Dryness, grittiness, scratchiness
Soreness or irritation
Burning or watering
Eye fatigue

Do you use eye drops and/or ointments?
Name of Eye Drops
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How long are they effective?
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Do the drops last 4 hours?
Do any gels last 12 hours?
Did you have Rosacea?
Do you use makeup?
Do you touch/rub your eyes?
Have you ever had a stye?
Have you ever been told you have Blepharitis?
Do you have Fluctuatin Vision problems? Does it improve when you blink?

Your Results

Discussing Your Results and Treatment Plan

Thank you for completing our dry eye risk assessment. Your responses will assist our eye doctors at The Lotus Eye Care in understanding your vision needs better. Expect a follow-up from our team to discuss your results and explore personalized treatment options tailored to your needs.

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