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DRY EYE QUESTIONNAIRE (DEQ-5)

Name *

1. Questions about EYE DISCOMFORT:

a. During a typical day in the past month, how often did your eyes feel discomfort? *
b. When your eyes feel discomfort, how intense was this feeling of discomfort at the end of the day, within two hours of going to bed? *

2. Questions about EYE DRYNESS:

a. During a typical day in the past month, how often did your eyes feel dry? *
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? *

3. Questions about WATERY EYES:

a. During a typical day in the past month, how often did your eyes look or feel excessively watery? *
Calculate score: 1a + 1b + 2a + 2b + 3
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Date *