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Dry Eye Quesionnaire
deq UAE
deq
1
Eye Lubricant
2
Eye Discomfort
3
Eye Dryness
4
Watery Eyes
Company
This field is for validation purposes and should be left unchanged.
Question 1 A
(Required)
Are you using Dry Eye Lubricant currently?
Yes
No
Question 1 B
(Required)
During a typical day in the past month, how often did your eyes feel discomfort?
NEVER
RARELY
SOMETIMES
FREQUENTLY
CONSTANTLY
Question 2 B
(Required)
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?
NEVER
HAVE IT
NOT AT ALL INTENSE
TOLERABLE
MODERATELY INTENSE
INTENSE
VERY
INTENSE
Question 1 C
(Required)
During a typical day in the past month, how often did your eyes feel dry?
NEVER
RARELY
SOMETIMES
FREQUENTLY
CONSTANTLY
Question 2 C
(Required)
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?
NEVER
HAVE IT
NOT AT ALL INTENSE
TOLERABLE
MODERATELY INTENSE
INTENSE
VERY
INTENSE
Question 1 D
(Required)
During a typical day in the past month, how often did your eyes look or feel excessively watery?
NEVER
RARELY
SOMETIMES
FREQUENTLY
CONSTANTLY
