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Dry Eye SPEED Questionnaire

  • Date Format: MM slash DD slash YYYY
  • Date Format: MM slash DD slash YYYY
  • Dry Eye Disease is the most frequent reason that patients visit eye doctors. We are concerned that you may be suffering with this condition as well. Therefore, we ask that you take a few moments and thoughtfully complete the questionnaire below.
  • 0 = Never
    1 = Sometimes
    2 = Often
    3 = Constant
    0123
    Dryness, Grittiness or Scratchiness
    Soreness or Irritation
    Burning or Watering
    Eye Fatigue
  • 0 = No problems
    1 = Tolerable – not perfect but not uncomfortable
    2 = Uncomfortable – irritating but does not interfere with my day
    3 = Bothersome – irritating and interferes with my day
    4 = Intolerable – unable to perform my daily tasks
    01234
    Dryness, Grittiness or Scratchiness
    Soreness or Irritation
    Burning or Watering
    Eye Fatigue
  • (That can be corrected with blinking)
x

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