0191 274 5385
info@visionclinicopticians.co.uk
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0191 274 5385
info@visionclinicopticians.co.uk
Book an appointment
Back
Our Services
Eye Examinations
Children’s Eye Tests
Contact Lenses
Dry Eye / IPL Clinic
Visual Field Test
Styling Consultation
Spectacle Repairs
Home Visits
Corporate Eyecare
School Visits
Myopia Management
OCT / Eye Scan
Night Lenses / OrthoK
0191 274 5385
info@visionclinicopticians.co.uk
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Dry Eye Assessments
Dry Eye Assessments
About you
Your first name
Your last name
Your email address
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1 of 5 - 0%
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Symptom Assessment
How often do you experience the following symptoms with your eyes?
Never
Sometimes
Frequently
Constantly
Dryness of the eyes
Burning or stinging sensation
Grittiness or sandy feeling
Redness
Sensitivity to light (photophobia)
Blurred or fluctuating vision
Excessive tearing watering of the eyes
2 / 5 - 40%
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Impact on Daily Life
How much do your dry eye symptoms interfere with your daily activities?
Never
Sometimes
Frequently
Constantly
Reading
Driving / Driving at Night
Using Computers / Devices
Watching TV
Outdoor Activities
3 / 5 - 60%
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Impact on Daily Life
Do you feel discomfort in any of the following conditions?
Never
Sometimes
Frequently
Constantly
Windy/Cold Weather
Places or areas with low humidity (very dry)
Areas that are air conditioned
Wearing contact lenses
4 / 5 - 80%
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