Do You Have Chronic Dry Eye?
Fill Out the Dry Eye Actionnaire.

Tell your eye doctor exactly how you feel about your current dry eye treatment. You may have Chronic Dry Eye (CDE). Answer ALL the ACTIONNAIRE questions below…and click the "FINISH ACTIONAIRRE" button at the bottom of the page. Make sure you take this with you when you visit your eye doctor.

Remember: only your eye doctor can determine what treatment is the best choice for managing your dry eye condition. So the more information you provide for your eye doctor, the more it will help your doctor select the treatment that works best for you.

1.Have you been using over-the-counter (OTC) eye drops for a long time?

Tell your eye doctor exactly how long:

2.Have you tried many types of OTC drops and artificial tears?

Tell your eye doctor exactly how many:

Tell your eye doctor their names: (Check all that apply)

3.Are you using OTC drops often?

Tell your eye doctor exactly how often:

4.Do you feel like your use of OTC drops has increased over time?

Tell your eye doctor exactly how much:

5.Are your dry eyes affecting your daily activities?

If you answered "yes", please let your doctor know what activities are affected:

6.Are you concerned about your dry eyes?

If you answered "Yes", tell your doctor how your eyes feel:

7.Are you satisfied with your current dry eye treatment?

If you answered "No," make sure you tell your eye doctor.

8.Are you ready to discuss treatment options for your dry eye with your doctor?

If you answered “Yes,” don’t wait for your annual appointment. Contact your eye doctor TODAY and make an appointment to discuss treatment options for your dry eye.

 

FINISH QUESTIONNAIRE