Are you wondering if you might have Dry Eye? Have your eyes been feeling dry, itchy, scratchy, achy, blurry, irritated, or tired? Have you been using artificial tears to lubricate your eyes?

Canadian eye care specialists have developed a quiz that is designed to help you and your optometrist or ophthalmologist determine whether you have Dry Eye and to rate its severity. The severity of Dry Eye symptoms can range from mildly irritating to severely disabling, and in many cases, symptoms can affect quality of life to some degree.1,2

Take the Canadian Dry Eye Assessment Quiz Now

Answer all the questions below then click the "Submit" button at the bottom of the page. Be sure to take a printout with you when you visit your optometrist or ophthalmologist.

Only your optometrist or ophthalmologist can determine what treatment is the best choice for managing your Dry Eye. This information will help them select the treatment that is best for you.

Remember: relief is available.


Name:

Date:

Canadian Dry Eye Assessment (CDEA)

Please complete this questionnaire. It will help to grade the severity of your Dry Eye symptoms. Bring the completed questionnaire with you to your optometrist or ophthalmologist.

Have you experienced any of the following symptoms?

0: None of the Time; 1: Some of the Time; 2: Half of the Time; 3: Most of the Time; 4: All of the Time

0
None of the Time

1
Some of the Time

2
Half of the Time

3
Most of the Time

4
All of the Time

Sensitivity to light, during the last week

Gritty or scratchy sensation, during the last week

Burning or stinging, during the last week

Blurred/unclear visions, during the last week

Vision that fluctuates with blinking, during the last week

Vision that improves with artificial tears, during the last week

Tearing/watering, during the last week

Pain/burning during the night or upon awakening in the morning, during the last week

Have you experienced eye irritation while performing any of these activities?

0: None of the Time; 1: Some of the Time; 2: Half of the Time; 3: Most of the Time; 4: All of the Time

0
None of the Time

1
Some of the Time

2
Half of the Time

3
Most of the Time

4
All of the Time

Reading or driving a car for long periods, during the last week

Watching TV/working on a computer for an extended period, during the last week

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

0: None of the Time; 1: Some of the Time; 2: Half of the Time; 3: Most of the Time; 4: All of the Time

0
None of the Time

1
Some of the Time

2
Half of the Time

3
Most of the Time

4
All of the Time

During winter/air draft exposure, during the last week

In places with low humidity (heated/cooled places, i.e planes), during the last week

How much do your eyes bother you? Please check box from 1–10

Not at all Moderately Extremely &
Constantly

Please Answer the following questions:

What brand of artificial tears are you using?

How often do you use artificial tears?

Times per day?

Days per week?

Are your symptoms better, worse or the same as your last visit?

  1. The Tear Film & Ocular Surface Society. 2007 Report of the International Dry Eye WorkShop (DEWS). Special Issue. The Ocular Surface 2007;5(2):67–204.
  2. Jackson WB. Management of dysfunctional tear syndrome. Can J Ophthalmol. 2009;44(4):385–394.