What is dry eye disease?

Dry eye disease (DED) is inflammation of the surface of the eye that decreases the quality and quantity of tears. This causes damage to the eye’s surface which then causes irritation. It affects approximately 30% of Canadians.

Common symptoms of DED:

1) Blurry (fluctuating vision)

2) Burning/Stinging

3) Dryness/scratchiness

4) Sensitivity to light

5) Eye redness

6) Excessive tearing

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How is DED treated?

There are many ways to treat dry eyes. The treatment of choice depends largely on the cause. Just a few initial options include tears/ointments and omega-3’s. Please visit our dry eye products page. Others can be drops to help reduce inflammation such as Restasis. Opteva Direct is a comprehensive patient support program that helps patients manage their dry eyes.

Please visit optevadirect.com or ask your optometrist if this program is right for you. Please book a dry eye assessment today to discuss treatment options.

Before your visit, please fill out this dry eye questionnaire first.

TAKE QUESTIONNAIRE

Dry Eye Questionnaire

Prefer to print out the form and email it in to us? Click here to download the PDF.

First Name*
Last Name*
Phone Number*
Email Address*
Have you experienced any of the following during the last week:
1 - Eyes that are sensitive to light?
- 4 - All of the time
- 3 - Most of the time
- 2 - Half of the time
- 1 - Some of the time
- 0 - None of the time
2 - Eyes that feel gritty?
- 4 - All of the time
- 3 - Most of the time
- 2 - Half of the time
- 1 - Some of the time
- 0 - None of the time
3 - Painful or sore eyes?
- 4 - All of the time
- 3 - Most of the time
- 2 - Half of the time
- 1 - Some of the time
- 0 - None of the time
4 - Blurred vision?
- 4 - All of the time
- 3 - Most of the time
- 2 - Half of the time
- 1 - Some of the time
- 0 - None of the time
5 - Poor vision?
- 4 - All of the time
- 3 - Most of the time
- 2 - Half of the time
- 1 - Some of the time
- 0 - None of the time
Subtotal score for answers 1 to 5
Have problems with your eyes limited you in performing any of the following during the last week:
6 - Reading?
- 4 - All of the time
- 3 - Most of the time
- 2 - Half of the time
- 1 - Some of the time
- 0 - None of the time
- N/A
7 - Driving at night?
- 4 - All of the time
- 3 - Most of the time
- 2 - Half of the time
- 1 - Some of the time
- 0 - None of the time
- N/A
8 - Working with a computer or bank machine (ATM)?
- 4 - All of the time
- 3 - Most of the time
- 2 - Half of the time
- 1 - Some of the time
- 0 - None of the time
- N/A
9 - Watching TV?
- 4 - All of the time
- 3 - Most of the time
- 2 - Half of the time
- 1 - Some of the time
- 0 - None of the time
- N/A
Subtotal score for answers 6 to 9
Have your eyes felt uncomfortable in any of the following solutions during the last week:
10 - Windy conditions?
- 4 - All of the time
- 3 - Most of the time
- 2 - Half of the time
- 1 - Some of the time
- 0 - None of the time
- N/A
11 - Places or areas with a low humidity (very dry)?
- 4 - All of the time
- 3 - Most of the time
- 2 - Half of the time
- 1 - Some of the time
- 0 - None of the time
- N/A
12 - Areas that are air conditioned?
- 4 - All of the time
- 3 - Most of the time
- 2 - Half of the time
- 1 - Some of the time
- 0 - None of the time
- N/A
Subtotal score for answers 10 to 12
Add all subtotals together to get your score
Total number of questions answered (Do not include questions answered N/A)
Email
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