Dry Eye Questionnaire Please answer the following questions by checking the box that best represents your answer. Select only one answer per question. 1. Do you experience EYE DISCOMFORT?a. During a typical day in the past month, how often did your eyes feel discomfort?* 0 - Never 1 - Rarely 2- Sometimes 3- Frequently 4- 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 2. Do you experience EYE DRYNESS?a. During a typical day in the past month, how often did your eyes feel dry?* 0 - Never 1- Rarely 2- Sometimes 3- Frequently 4- 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 Very intense 3. Do you have WATERY EYES?During a typical day in the past month, how often did your eyes look or feel excessively watery?* 0 - Never 1- Rarely 2- Sometimes 3- Frequently 4 - Constantly HiddenScore