Dry Eye Questionnaire Name* First Last Phone*Email 1. Questions about EYE DISCOMFORTa. During a typical day in the past month, how often did your eyes feel discomfort?* Never Rarely Sometimes Frequently Constantly 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?* 0 - Never have it 1 - Not at all intense 2 3 4 5 - Very intense 2. Questions about EYE DRYNESSa. During a typical day in the past month, how often did your eyes feel dry?* Never Rarely Sometimes Frequently Constantly 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?* 0 - Never have it 1 - Not at all intense 2 3 4 5 - Very intense 3. Question about WATERY EYESDuring a typical day in the past month, how often did your eyes look or feel excessively watery?* Never Rarely Sometimes Frequently Constantly Score