DRY EYE QUESTIONNAIRE (DEQ-5)

Name

Phone Number

Email

What is your age group?

1. Questions about EYE DISCOMFORT:


a. During a typical day in the past month, how often did your eyes feel discomfort?
b. When your eyes felt discomfort, how intense was this feeling of discomfort at the end of the day, within two hours of going to bed?

2. Questions about EYE DRYNESS:


a. During a typical day in the past month, how often did your eyes feel dry?
b. When your eyes felt dry, how intense was this feeling of dryness at the end of the day, within two hours of going to bed?

3. Questions about WATERY EYES:


During a typical day in the past month, how often did your eyes look or feel excessively watery?

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