DRY EYE QUESTIONNAIRE

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Ocular Surface Disease Index© (OSDI©)2

Answer the following 12 questions, and click the selection that best represents each answer. Add your points and fill in the total after each section.

All of the time = 4 points | Most of the time = 3 points | Half of the time = 2 points | Some of the time = 1 points | None of the time = 0 points

Have you experienced any of the following during the last week?

1. Eyes that are sensitive to light? *

All of the time (4)

Most of the time (3)

Half of the time (2)

Some of the time (1)

None of the time (0)

2. Eyes that feel gritty? *

All of the time (4)

Most of the time (3)

Half of the time (2)

Some of the time (1)

None of the time (0)

3. Painful or sore eyes? *

All of the time (4)

Most of the time (3)

Half of the time (2)

Some of the time (1)

None of the time (0)

4. Blurred vision? *

All of the time (4)

Most of the time (3)

Half of the time (2)

Some of the time (1)

None of the time (0)

5. Poor vision? *

All of the time (4)

Most of the time (3)

Half of the time (2)

Some of the time (1)

None of the time (0)

Subtotal score for answers 1 to 5

Have, problems with your eyes, limited you in performing any of the following during the last week?

6. Reading? *

All of the time (4)

Most of the time (3)

Half of the time (2)

Some of the time (1)

None of the time (0)

7. Driving at night? *

All of the time (4)

Most of the time (3)

Half of the time (2)

Some of the time (1)

None of the time (0)

8. Working with a coputer or bank machine (ATM) *

All of the time (4)

Most of the time (3)

Half of the time (2)

Some of the time (1)

None of the time (0)

9. Watching TV? *

All of the time (4)

Most of the time (3)

Half of the time (2)

Some of the time (1)

None of the time (0)

Subtotal score for answers 6 to 9

Have your eyes felt uncomfortable in any of the following situations during the last week?

10. Windy Conditions *

All of the time (4)

Most of the time (3)

Half of the time (2)

Some of the time (1)

None of the time (0)

11. Places or areas with low humidity (very dry)? *

All of the time (4)

Most of the time (3)

Half of the time (2)

Some of the time (1)

None of the time (0)

12. Areas that are air conditioned? *

All of the time (4)

Most of the time (3)

Half of the time (2)

Some of the time (1)

None of the time (0)

Subtotal score for answers 10 to 12

Now add Subtotals A + B + C

Assessing Your Dry Eye Disease

Use your TOTAL to compare with the chart below. Find where your score would fall. Determine whether your score indicates normal, mild, moderate, or severe dry eye disease.