Dry Eye Relief Questionnaire

Take 1 minute to find out what’s causing your dry eyes—and how we can help.

Thank you! Our dry eye team will review your responses and reach out soon to share how we can help you find lasting relief.

In the meantime, please visit our Dry Eye Relief Center to learn more about dry eye treaments we offer.

1. Do you experience any of the following symptoms regularly? (Check all that apply)

Burning or stingingGritty or sandy feelingBlurred or fluctuating visionExcessive tearing or watery eyesRedness or irritationLight sensitivityTired or heavy eyesNone of the above

2. How long have you been experiencing these symptoms?

Less than 1 month1-6 monthsOver 6 monthsSeveral years

3. When do your symptoms usually feel worse? (Select all that apply)

In the morningAt the end of the dayWhile using screens or readingIn air-conditioned or windy environmentsDuring allergy season

4. Have you tried any of the following treatments? (Check all that apply)

Artificial tears or lubricating eye dropsWarm compressesLid scrubs or wipesng screens or readingPrescription drops (e.g., Xiidra, Restasis)Punctal plugsIn-office treatments (e.g., IPL, LipiFlow)None of the above

Dry Eye Relief Questionnaire

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