Dry Eye Quiz

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Primary Eyecare Associates

8436 Vaughn Rd. Montgomery, AL 36117 - Phone: (334) 271-3900

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Have you experienced any of the following during the last week?
Eyes that are sensitive to light?	All of the time	Most of the time	Half of the time	Some of the time	None of the time
Eyes that feel gritty?	All of the time	Most of the time	Half of the time	Some of the time	None of the time
Painful or sore eyes?	All of the time	Most of the time	Half of the time	Some of the time	None of the time
Blurred vision?	All of the time	Most of the time	Half of the time	Some fo the time	None of the time
Poor vision?	All of the time	Most of the time	Half of the time	Some of the time	None of the time
Have problems with your eyes limited you in performing any of the following during the last week?
Reading?	All of the time	Most of the time	Half of the time	Some of the time	None of the time	N/A
Driving at night?	All of the time	Most of the time	Half of the time	Some of the time	None of the time	N/A
Working with a computer or bank machine (ATM)?	All of the time	Most of the time	Half of the time	Some of the time	None of the time	N/A
Watching TV?	All of the time	Most of the time	Half of the time	Some of the time	None of the time	N/A
Have your eyes felt uncomfortable in any of the following situations during the last week?
Windy conditions?	All of the time	Most of the time	Half of the time	Some of the time	None of the time	N/A
Places or areas with low humidity (very dry)?	All of the time	Most of the time	Half of the time	Some of the time	None of the time	N/A
Areas that are air-conditioned?	All of the time	Most of the time	Half of the time	Some of the time	None of the time	N/A

Dry Eye Quiz

Do You Have Chronic Dry Eye?

Have you experienced any of the following during the last week?

Eyes that are sensitive to light?

Eyes that feel gritty?

Painful or sore eyes?

Blurred vision?

Poor vision?

Have problems with your eyes limited you in performing any of the following during the last week?

Reading?

Driving at night?

Working with a computer or bank machine (ATM)?

Watching TV?

Have your eyes felt uncomfortable in any of the following situations during the last week?

Windy conditions?

Places or areas with low humidity (very dry)?

Areas that are air-conditioned?

Dry Eye Quiz

Do You Have Chronic Dry Eye?

Have you experienced any of the following during the last week?

Eyes that are sensitive to light?

Eyes that feel gritty?

Painful or sore eyes?

Blurred vision?

Poor vision?

Have problems with your eyes limited you in performing any of the following during the last week?

Reading?

Driving at night?

Working with a computer or bank machine (ATM)?

Watching TV?

Have your eyes felt uncomfortable in any of the following situations during the last week?

Windy conditions?

Places or areas with low humidity (very dry)?

Areas that are air-conditioned?

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