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Dry Eye Quiz

Dry Eye Quiz

For the Standardized Patient Evaluation of Eye Dryness (SPEED) Questionnaire, please answer the following questions by checking the box that best represents your answer. Select only one answer per question.

Report the SYMPTOMS you experience and when they occur:

Symptoms At This Visit Within Past 72 Hours Within Past 3 Months
Dryness, Grittiness or Scratchiness Yes No Yes No Yes No
Soreness or Irritation Yes No Yes No Yes No
Burning or Watering Yes No Yes No Yes No
Eye Fatigue Yes No Yes No Yes No

Report the FREQUENCY of your symptoms using the rating list below:
(0 = Never, 1 = Sometimes, 2 = Often, 3 = Constant)

Dryness, Grittiness, or Scratchiness

Soreness or Irritation

Burning or Watering

Eye Fatigue

Report the SEVERITY of your symptoms using the rating list below:
(0 = No Problems, 1 = Tolerable, 2 = Uncomfortable, 3 = Bothersome, 4 = Intolerable)

Dryness, Grittiness or Scratchiness

Soreness or Irritation

Burning or Watering

Eye Fatigue

Do you use eye drops for lubrication? If yes, how often?

Please list your symptoms and any other additional comments